English Debate

Topic: Euthanasia / Mercy Killings (Affirmative)

DEFINITION:
Euthanasia (from Greek: εὐθανασία; "good death": εὖ, eu; "well" or "good" – θάνατος, thanatos; "death") is
the practice of intentionally ending a life in order to relieve pain and suffering. The British House of Lords
Select Committee on Medical Ethics defines euthanasia as "a deliberate intervention undertaken with the
express intention of ending a life, to relieve intractable suffering". Euthanasia is categorized in different
ways, which include voluntary, non-voluntary, or involuntary. Voluntary euthanasia is legal in some
countries. Non-voluntary euthanasia (patient's consent unavailable) is illegal in all countries. Involuntary
euthanasia (without asking consent or against the patient's will) is also illegal in all countries and is usually
considered murder. As of 2006, euthanasia is the most active area of research in contemporary  bioethics.
However, it is argued that this approach fails to properly define euthanasia, as it leaves open a number of
possible actions which would meet the requirements of the definition, but would not be seen as euthanasia.
In particular, these include situations where a person kills another, painlessly, but for no reason beyond that
of personal gain; or accidental deaths that are quick and painless, but not intentional. The third element
incorporated into many definitions is that of intentionality – the death must be intended, rather than being
accidental, and the intent of the action must be a "merciful death". Michael Wreen argued that "the principal
thing that distinguishes euthanasia from intentional killing simpliciter is the agent's motive: it must be a good
motive insofar as the good of the person killed is concerned."

Euthanasia can all be divided into passive or active variants. Passive euthanasia entails the withholding of
common treatments, such as antibiotics, necessary for the continuance of life. Active euthanasia entails the
use of lethal substances or forces, such as administering a lethal injection, to kill and is the most
controversial means. A number of authors consider these terms to be misleading and unhelpful. Active non-
voluntary euthanasia is illegal in all countries in the world, although it is practiced in the Netherlands on
infants under an agreement between physicians and district attorneys. Passive non-voluntary euthanasia
(withholding life support) is legal in various countries, such as India, Albania, and many parts of the United
States and is practiced in English hospitals.

FOUR TYPES OF EUTHANASIA:

 Child Euthanasia - is a controversial form of euthanasia that is applied to children who are gravely
ill or suffer from significant birth defects. Generally, when a newborn's life is contested, the parents
are the ones who determine their child’s future. The parents and the doctor both take part in
making the decision. When there is persistent disagreement, the case may be taken to court where
the decision is made. The concept of child euthanasia has sparked heavy debate. For example,
Eric Kodish and Daniel A Beals have compared child euthanasia to infanticide. Kodish says "the
very notion that there is an “accepted medical standard” for infanticide calls for resistance in the
 form of civil disobedience". Others, such as Joseph Fletcher, founder of situational ethics and a
euthanasia proponent, proposed that infanticide be permitted in cases of severe birth defects.
Fletcher says that unlike the sort of infanticide perpetrated by very disturbed people, in such cases
child euthanasia could be considered humane; a logical and acceptable extension of abortion.

 Voluntary Euthanasia - Voluntary euthanasia is the practice of ending a life in a painless manner.
Voluntary euthanasia (VE) and physician-assisted suicide (PAS) have been the focus of great
controversy in recent years. Voluntary refusal of food and fluids (VRFF) or Patient Refusal of
Nutrition and Hydration (PRNH) is bordering on euthanasia. Some authors classify it as a form of
passive euthanasia, while others treat it separately because it is treated differently from legal point
of view and often perceived as a more ethical option. VRFF is sometimes suggested as a legal
alternative to euthanasia in jurisdictions disallowing euthanasia.

 Non Voluntary Euthanasia - is euthanasia conducted when the explicit consent of

the individual concerned is unavailable, such as when the person is in a persistent vegetative state,
or in the case of young children. It contrasts with involuntary euthanasia, when euthanasia is
performed against the will of the patient. The different possible situations considered non-voluntary
euthanasia are when the decision to end the life of the patient is 1) based on what the
incapacitated individual would have wanted if they could be asked, 2) based on what the decision
maker would want if he or she were in the patient's place, and 3) made by a doctor based on their
own criteria and reasoning.

 Involuntary Euthanasia - occurs when euthanasia is performed on a person who would be able to

provide informed consent, but does not, either because they do not want to die, or because they
were not asked. Involuntary euthanasia is contrasted with voluntary euthanasia (euthanasia
performed with the patient's consent) and non-voluntary euthanasia(when the patient is unable to
give informed consent, for example when a patient is comatose or a child). Involuntary euthanasia
is widely opposed and is regarded as a crime in all legal jurisdictions. Reference to it or fear of it is
sometimes used as a reason for not changing laws relating to other forms of euthanasia.

ADDITIONAL TERMS TO BE NOTED:

 Abortion – (for child euthanasia) is the ending of pregnancy by removing a fetus or embryo before it
can survive outside the uterus. An abortion may be caused purposely and is then called an induced
abortion, or less frequently, "induced miscarriage". The word abortion is often used to mean only
induced abortions. A similar procedure after the fetus could potentially survive outside the womb is
known as a "late termination of pregnancy". Reasons for procuring induced abortions are typically
characterized as either therapeutic or elective. An abortion is medically referred to as a therapeutic
abortion when it is performed to save the life of the pregnant woman; prevent harm to the
woman's physical or mental health; terminate a pregnancy where indications are that the child will
have a significantly increased chance of premature morbidity or mortality or be otherwise disabled;
 or to selectively reduce the number of fetuses to lessen health risks associated with multiple
pregnancy. An abortion is referred to as an elective or voluntary abortion when it is performed at
the request of the woman for non-medical reasons.

 Physician Assisted Suicide (PAS) – (for voluntary euthanasia) FALLS UNDER ASSISTED
SUICIDE: involves a doctor "knowingly and intentionally providing a person with the knowledge or
means or both required to commit suicide, including counseling about lethal doses of drugs,
prescribing such lethal doses or supplying the drugs. One argument for assisted suicide or medical
aid in dying is that it reduces prolonged suffering in those with terminal illnesses. When death is
imminent (6 months or less) patients can choose to have aid in dying as a medical option to
shorten an unbearable dying process. The three most frequently mentioned end‐of‐life concerns
reported by Oregon residents who took advantage of the Death With Dignity Act in 2015 were:
decreasing ability to participate in activities that made life enjoyable (96.2%), loss of autonomy
(92.4%), and loss of dignity (75.4%) 

 Voluntary Refusal of Foods and Fluids (VRFF) – (for voluntary euthanasia) also known as terminal
dehydration. Defined as the dehydration to the point of death, potentially as a suicide method.
Some scholars make a distinction between "terminal dehydration" and "termination by
dehydration". Terminal dehydration (also known as voluntary death by dehydration or VDD) has
been described as having substantial advantages over physician-assisted suicide with respect to
self-determination, access, professional integrity, and social implications. Specifically, a patient has
a right to refuse treatment and it would be a personal assault for someone to force water on a
patient, but such is not the case if a doctor merely refuses to provide lethal medication.

 Patient Refusal of Nutrition and Hydration (PRNH) - (for voluntary euthanasia) People who feel
they are near the end of their life often refuse food and/or water. Published studies indicate that
"within the context of adequate palliative care, the refusal of food and fluids does not contribute to
suffering among the terminally ill", and might actually contribute to a comfortable passage from life:
"At least for some persons, starvation does correlate with reported euphoria."

RELIGIOUS VIEWS ON EUTHANASIA

The Roman Catholic view on euthanasia is a grave violation of the law of God, since it is the
deliberate and morally unacceptable killing of a human person. The Roman Catholic
Church regards euthanasia as morally wrong. It has always taught the absolute and unchanging value of
the commandment "You shall not kill". Christians are mostly against euthanasia. The arguments are usually
based on the beliefs that life is given by God, and that human beings are made in God's image. Some
churches also emphasize the importance of not interfering with the natural process of death.
Pope John Paul II has spoken out against what he calls a 'culture of death' in modern society, and said that
human beings should always prefer the way of life to the way of death. The church regards any law
permitting euthanasia as an intrinsically unjust law.

Life is a thing of value in itself; its value doesn't depend on the extent that it brings pleasure and well-being.
This means that suffering and pain do not stop life being valuable, and are not a reason for ending life. The
church believes that each person should enter the dying process with all its mysteries with trust in God and
in solidarity with their fellow human beings; they should die with the dignity of letting themselves be loved
unconditionally.

The Roman Catholic Church does not accept that human beings have a right to die. Human beings are free
agents, but their freedom does not extend to the ending of their own lives. Euthanasia and suicide are both
a rejection of God's absolute sovereignty over life and death.

The church believes that each human life is a manifestation of God in the world, a sign of his presence, a
trace of his glory. "The life which God offers to man is a gift by which God shares something of himself with
his creature." A human being who insists that they have the 'right to die' is denying the truth of their
fundamental relationship with God.

VIEWS ON EUTHANASIA IN THE PHILIPPINES

Possibly the first in the history of the Congress of the Philippines, a  voluntary euthanasia or mercy killing
and “living will-related” proposal known as Senate Bill No. 1887 or the Natural Death Act was filed by
Senator Miriam Defensor-Santiago. The bill seeks to recognize the fundamental right of adult persons to
decide their own health care, including the decision to have life-sustaining treatment withheld or withdrawn
in instances of a terminal condition or permanent unconscious condition.

Over the past two decades, an end-of-life policy unfolded quietly in some parts of the world. In the US, the
Death With Dignity Act (1994) in Oregon allows doctors to write legal prescriptions for terminally ill patients
who want to control the time and place of their death. To qualify under the law, the patient should be fully
conscious and able to administer his own overdose. In Europe, Belgium is set to be the second country
after The Netherlands to allow terminally ill children over 12 years old facing unbearable physical suffering
and repeatedly makes the request to be officially killed. Belgium and Switzerland have legalized euthanasia
for many years but only for people over the age of 18. The Netherlands have legalized euthanasia for
adults and children over 12 years for the past twelve years.

Mercy killing or euthanasia was a favorite topic of debate in Philippine law schools during the last fifty years
or so. Now that a bill is with the Senate, among many questions Filipinos wish to be answered to have an
in-depth understanding of the subject that will enable them to make an informed   yes or no and why in case
of renewed debates, survey or referendum, are: What is euthanasia or mercy killing ? What is the
difference between voluntary and involuntary mercy killing? What is a “living will”? May human life be
shortened legally? Should one kill another in mercy, or is life, however hard too dear to lose? What is the
rule in our jurisdiction on mercy killing and assisted suicide? Is the mercy motive an element of a crime or
defense to its existence? Out of compassion for a suffering patient, must we legalize euthanasia
altogether? Out of compassion for the actor, must we mitigate the harshness of formal law under which
euthanasia is treated as deliberate killing?

If an individual has the right to live, does he also have the right to die? If there is a right to privacy, does it
include the right to die? Does the right to decide one’s health care include the right to decide to end one’s
life? Is there a right to kill? Is there a point at which an incurable illness becomes a living death? If so, is it
permissible for someone’s life to be deliberately cut off ? What are the religious, non-religious and medical
views about euthanasia?

When does human life end?  What is “brain death”? Is persistent vegetative state the same as being brain
dead? When is a person legally and medically dead? What is an acceptable legal and medical definition of
“terminal condition or permanent unconscious condition”?  Who has the right to make the decision to end
life–the patient, the spouse, the parents, the doctor/team of doctors or the courts?  Who should “pull the
plug?” A black hooded executioner?

The complex life-and-death problems raised by the scientific advances in the field of medicine have no
simple answers. Intimately involved in the issues besides physicians and lawyers are theologians, the
courts, lawmakers, psychologists, sociologists, ethicists among others. Expert advice is needed from many
fields on this culture-of-life vs. emerging end-of-life policy.

- The Manila Times

 The miracles of the increasing availability of medical technology are a tremendous intervention in saving
human lives. But they can also bear out a curse by prolonging the dying process of a gravely ill patient at
the cost of great suffering and expense. The cost of futile life-prolonging treatment is often exorbitant, but
still ends up hopelessly towards death. This circumstance just forces the patient to a miserable existence.
Thus, it is important to consider the right of a dying person to remain in charge of his body, choosing when
to fight for his life and when to allow him to die, even though it is the sole responsibility of the physician to
keep him alive. Euthanasia benefits this choice of the patient to consult to his death in order to relieve the
excruciating pain from incurable and terminal diseases; however, the legalization of this in the Philippines is
contradicted by religious communities.

All types of euthanasia applies methods such as removing the life-supporting devices, injection of drugs,
inhalation of carbon monoxide or helium, dehydration, and intake of suicide pills. However, moral and
ethical methods, such as voluntary euthanasia, and methods not involving painful outcomes are the ones
commonly practiced. These methods are done to patients who are terminally-ill; that is patients who have
impossible chance of recovering from the disease, or if ever cured, does not function in good health and will
be under vegetative state.
In the Philippines, euthanasia is not legal for the reason of the predominance of the religious communities
which hinders the ratification of the Euthanasia Bill. Also, the majority of the Filipinos value the Christian
doctrine as the foundation of their conviction. However, it is still practiced by some, mostly are from the
poor segment of the country. They have no other choice but to use euthanasia to stop the patient from
suffering, and to avoid expenses on medical treatments. Additionally, medical technologies and
professionals here in the Philippines are not entirely advanced. Common Filipino physicians may have
inadequate skills to efficiently cure complicated diseases. If medications reach to the point of life-or-death
matter, operations, at times, result to failure, making all treatments paid by the relatives of the patient result
in vain.. Likewise, medical technologies are not completely available to cure various diseases; if ever it is, it
will cost a tremendous price.

 The stand of the Church that euthanasia is still immoral and unethical is the prime reason of the
unacceptability of this. According to the most recent version of the Catechism of the Catholic Church
(2003), “All forms of suicide and euthanasia remain strictly prohibited… Voluntary co-operation in suicide is
contrary to the moral law… Sick or handicapped persons should be helped to lead lives as normal as
possible.” And according to Pope John Paul II, “Euthanasia must not be called false mercy, and indeed a
disturbing perversion of mercy. True compassion leads to sharing another’s pain. It does not kill the person
whose suffering we cannot bear.” Also, some people believe that compassion is no guarantee against
doing harm. A physician who does not know how to relieve a patient’s suffering may compassionately, but
inappropriately, agree to end the patient’s life. Patient autonomy is just an illusion when physicians are not
trained to assess and treat patient suffering. The less they know how to treat these suffering, the more they
favor assisted suicide or euthanasia; and the more frequent they do it, the more they prescribe it. Until,
then, the only choices left for patients become continued agony or a hastened death. A part of the
Hippocratic Oath states that physicians must value the life of their patient and never suggest anyone a way
towards suicide. Under the Philippine Constitution of 1987 (Article II, Section 11), the State values the
dignity of every human person and guarantees full respect for human rights. Therefore, euthanasia
contradicts both the Hippocratic Oath and the Philippine Constitution.

In contrast, Euthanasia gives terminally-ill patients a medical treatment of choosing between a prolonged
life of agonizing pain or a peaceful death. It is not a compulsory treatment, in which every patient who has
little or no chance of recovering will have to choose euthanasia. Euthanasia is granted with the will of the
patient or the surrogate of the patient and it is only upon their request that physicians perform it. The
legalization of euthanasia does not aspire to violate the ethical and moral code, but rather just provide an
option to those who need it. For example, to consider that financial cost of keeping a person alive being
dependent on a life-support machine is very enormous, and that 80% of the Filipinos live in poverty, how
can the family afford keeping the patient on life support, knowing that the patient will be in vegetative state,
no matter how he was kept alive? With the statistics that only 2 out of 10 terminally-ill patients survives
because of proper medication, it is then illogical to hope for the patient with no enough money for
medication to recover from severe diseases; this then results to euthanasia. And since euthanasia takes
place anyway, even without the ratification of the bill, it is better to legalize it so that it will be practiced
under careful guidance, doctors will have to report these activities, and so that physicians will not have any
responsibility over the death of the patient.

Euthanasia, even though contradicted by religious communities, still has to be legalized for the benefit of
the incurable and hopeless patients, including their relatives. This legalization will improve further the
system of planning, performing, and recording of euthanasia, since it takes place inevitably. Likely, the
issue regarding the ratification of the Euthanasia Bill of the Philippines is still on its formative period, in
which there is no consistency whether where the topic will go further in the future. With both sides reflected
in the preceding paragraphs, it is evident that, it could become a loud argument, once again, especially
between the State and the Church.

- Hedin, H. (2004)

NATURAL DEATH ACT

NATURAL DEATH ACT or SENATE BILL NO. 1887 (also known as Death with Dignity Acts and Living
Will Acts) are laws that determine in what situations, and how, people can refuse life-sustaining medical
interventions. The purpose of these laws is to permit patients to choose a "natural" death, unencumbered
by medical technology. The laws are a response to the great strides made by medical science over the last
half of the twentieth century in prolonging the life of the chronically and severely ill. Concerns arose that
medical technology that could forestall death, such as respirators and feeding tubes, increased the agony
of dying. It also spawned concerns that an individual's right to autonomy and  self-determination could be
infringed by such invasive technology.

Excerpt from the Natural Death Act of the Philippines:

Adult persons have the fundamental right to decide their own health care, including the decision to
have life-sustaining treatment withheld or withdrawn in instances of a terminal condition or permanent
unconscious condition.

Modern medical technology has made possible the artificial prolongation of human life beyond
natural limits. Such prolongation of the process of dying for persons with a terminal condition or permanent
unconscious condition may cause loss of patient dignity, and unnecessary pain  and suffering, while
providing nothing medically necessary or beneficial to the patient. Physicians and nurses should not
withhold or unreasonably diminish pain medication for patients in a terminal condition where the primary
intent of providing such medication is to alleviate pain and maintain or increase the patient’s comfort.

There exists considerable uncertainty in the medical and legal professions as to the legality of
terminating the use or application of life-sustaining treatment where the patient having the capacity to
make health care decisions has voluntarily evidenced a desire that such treatment be withheld or
withdrawn.

In the interest of protecting individual autonomy, and in recognition of the dignity and privacy which
patients have a right to expect, our laws should recognize the right of an adult person to make written
directive instructing such person’s physician to withhold or withdraw life-sustaining treatment in the event of
a terminal condition or permanent unconscious condition. A person’s right to control his or her health care
may be exercised by an authorized representative who validly holds the person’s durable power of
attorney for health care.

HIPPOCRATIC OATH WITH REGARDS TO EUTHANASIA

A key thing that distinguishes a profession, and particularly the medical profession, from a trade or
association of technicians is the idea that a profession has a set of moral standards which helps to define
the profession. Historically, the Hippocratic Oath was the thing that set physicians apart as a profession.
There are several things about that historic oath which led to physicians being seen as part of a profession
that was respected for its moral standing. One of those was recognizing a higher moral authority before
which the oath was sworn. Another was a commitment to doing what was best for the patient. There was
also a specific list of things which the Hippocratic physician would not do, the things that were ethically
prohibited. This included administering poison (euthanasia), abortion, surgery (which the Hippocratic
physician was not trained to do), and taking advantage of anyone in the household of those being treated
(particularly sexually). Those prohibitions make it clear that there are moral standards which take
precedence over the individual physician’s judgment. It seems to me that this submission to moral
standards which are grounded in a higher moral authority is the thing that has traditionally given the
medical profession a unique moral standing in society.

It is the moral standing of the medical profession in society that makes it important for those who support
physician-assisted suicide and other forms of euthanasia to propose that physicians play a key role in the
administration of death. The involvement of physicians appears to transfer the moral standing of the
medical profession to the action being done. The problem with this is that by taking on the authority of
deciding who will die by physician-assisted suicide or euthanasia the physician is violating the key thing
that gives the medical profession its moral standing. By making the decision to provide lethal medication for
the person requesting physician-assisted suicide or administering lethal medication to the person receiving
active euthanasia the physician has taken on the authority of being able to determine that another person’s
life is not worth living. By doing so the physician is saying that there is not a higher moral authority to which
physicians are subject and there are not distinct boundaries which a physician should not cross in doing
what seems to the physician to be best for the patient. Since it was the acceptance of a higher moral
authority and specific boundaries that has given the medical profession its moral standing in society, the
abandonment of those things and the assumption of unlimited moral authority by the physician undermines
the basis for society’s moral respect for the medical profession. In the end, the involvement of physicians in
physician-assisted suicide and other forms of euthanasia does not give moral certification to those actions,
but instead leads to the loss of moral standing for the medical profession.
Statements To Take Note (PRO):

"Because the Hippocratic Oath instructs physicians not to provide a 'deadly drug,' some have concluded
that physicians, by their training and moral commitment, must necessarily reject assistance in hastening
death. This is not so. The provision in the Hippocratic Oath that prohibits providing a deadly drug did not
even reflect accepted medical practice in ancient Greek city-states where, upon request, a physician could
provide a lethal drug for a suffering patient. In some sense, physicians who provide assistance in hastening
death are adhering to a longstanding understanding of the scope of medical practice: to care for and meet
the needs and desires of a patient in all stages of the patient’s life. Significantly, the activities a physician
undertakes in providing assistance in hastening death are the same as those often carried out by a
physician who oversees a withdrawal of treatment. As a purely medical matter, there is little to distinguish a
physician’s activities in withdrawing treatment from activities in hastening death through other means."

"Hippocrates did not make a moral statement about whether or not euthanasia or abortions were right or
wrong. One of his works, Dismembering of the Fetus in the Womb, even explains how to perform an
abortion. His message in the Oath was that physicians were in the business of life and… Giving a
concoction to induce an abortion can be done without any particular healing knowledge. Likewise,
euthanasia is not a complicated process."

"The Hippocratic Oath is not the only time-honored school of ethical and moral thought to be discarded
because of inflexibility. Rules stated as always or never are sooner or later discredited by failure to
withstand the 'Yes but, what if...?' questions. The oath’s didactic references to abortion and euthanasia are
too simplistic to be useful to those seriously debating the professional, political, ethical and religious
aspects of these complex topics. Perhaps it is not necessary for a pledge of professionalism to be so
specific. If it is necessary, then Hippocrates fails us by omitting mention of stem cell research and genetic
engineering."

"The history of the euthanasia debate and descriptions in the of the care of dying persons in ancient
Greece make it unlikely that 'I will not give a drug that is deadly' refers to anything like our concepts of
physician-assisted suicide, voluntary or non-voluntary euthanasia, or discontinuing life-sustaining
treatment....The Greek-derived word euthanasia (literally: 'good death') was not coined until 280 BCE,
about a century after the Oath was written. This new word did not refer to assisting death; it referred to a
natural death without agony."

"Many opponents of [euthanasia and physician-assisted suicide] point to the Hippocratic Oath and its
prohibition on hastening death. But those who turn to the oath in an effort to shape or legitimize their ethical
viewpoints must realize that the statement has been embraced over approximately the past 200 years far
more as a symbol of professional cohesion than for its content. Its pithy sentences cannot be used as all-
encompassing maxims to avoid the personal responsibility inherent in the practice of medicine. Ultimately,
a physician's conduct at the bedside is a matter of individual conscience. The wisdom of past years and
moments enters into the deliberation, but decision making in the present bears a burden that is unique to
the particular transaction between the doctor and the individual patient who has come for help. To seek
refuge in ancient aphorisms is to turn away from the unique needs of each of our patients who have
entrusted themselves to our care."

"At the time of Hippocrates, there was no prohibition against physician-assisted suicide in mainstream
Greek medicine... neither the Hippocratic Oath nor classical tradition provides a compelling ethical or
professional prohibition of physician-assisted suicide."

"In the time of Hippocrates, physicians had no drugs of therapeutic efficacy by present standards, but they
did have poisons which were sometimes used on non-dying patients for mischievous purposes. In this
context, the Hippocratic injunction against the use of deadly drugs was good public relations for the medical
guild, and had nothing to do with terminally-ill patients.  …The context in which physicians might end
patients' lives has changed. Hippocrates never had a patient on a ventilator. As recently as about thirty
years ago no physician had a patient with recurrence of leukemia after bone marrow transplantation.
Modern medicine has changed the context in which patients now die, from one natural death with relative
impotence of physicians to change the course of dying, to medical prolongation of life resulting in different
and unnatural forms of dying. The injunction against lethal drugs in the old context of dying remains valid,
but we rightly should reassess it in the context of modern forms of dying. …The physician who prolongs her
patient’s life, but who then aids in the patient’s request to die, has not violated the Hippocratic injunction,
and in fact has fulfilled the physician’s duty to heal so far as is reasonable without producing harm."

DRAWING A LINE BETWEEN KILLING AND LETTING DIE

Traditional medical ethics and law draw a sharp distinction between allowing a patient to die and helping
her die. Withholding or withdrawing life sustaining treatment, such as by abating technological nutrition,
hydration or respiration, will cause death as surely as a lethal injection. The former, however, is a
constitutional right for a competent or once-competent patient, while the latter poses a risk of serious
criminal or civil liability for the physician, even if the patient requests it.

While much has been written about the professional ethics of physician assisted dying, little is known about
where the law draws the line, whether the law is enforced in practice, and how the law should be reformed
to reflect changing public opinion and ethical thought. This article addresses these questions and the need
for clearer public policy on physician assisted dying.

A substantial body of court decisions and scholarly publications has established that the risk of criminal
liability for withdrawing or withholding treatment in accordance with the wishes of a patient or her surrogate
is vanishingly small. The abatement of treatment is not an affirmative act, but rather a failure to provide
further treatment. There is no criminal liability for failure to act unless there is a legal duty to act. The
physician certainly has a duty toward her patients and ordinarily must use professional skill to promote the
patient's health and save life. No duty to provide treatment arises, however, where a patient or her
surrogate requests abatement of treatment. The courts are still developing the exact parameters of the right
to have treatment withheld or withdrawn. Certainly, a clear expression by a currently competent adult to
abate treatment must be respected by the physician. Elizabeth Bouvia, for example, could require removal
of a nasogastric tube, pursuant to her belief that the burdens of artificial feeding outweighed the benefits of
continued life with quadriplegia. Modern courts have tended also to respect the wishes of patients to refuse
a blood transfusion pursuant to their religious beliefs. The decision to abate treatment belongs to the
currently competent patient, not her physician, relatives or the courts. Nor must a competent patient be
comatose or terminally ill to refuse treatment. Courts have extended this nearly absolute right of self-
determination to incompetent patients whenever there is clear evidence that the patient, while competent,
would have declined treatment. Courts, however, understandably look searchingly at the patient's medical
condition or prognosis before sanctioning surrogate decisions for incompetent patients who have not
expressed a clear position for abating treatment. The physician certainly has no duty to treat when the
surrogate makes a request on behalf of a patient who is terminally ill or in a persistent vegetative state. Nor
have modern courts required judicial approval for these decisions to abate treatment. The physician's legal
responsibilities are much less certain when the patient has a chronic disease with a low quality of life, such
as dementia. A physician would be unwise to abate life sustaining treatment in such a case unless that.

The determination of what is criminal and what is lawful is not understood by examining the physician's
motives. The fact that a physician is motivated by the desire to end unendurable pain and suffering is
irrelevant to criminal liability. The critical element is intent or knowledge. Did the physician intend to kill or
know that death would result? Thus, a physician who injects or prescribes a sedative with the primary intent
of reducing suffering would be acting lawfully even if she were aware of the depression of respiration. If the
physician intended or knew the medication would depress respiration sufficient to cause death, criminal
liability could ensue. This is no easy distinction to make in practice, but the law appears to rely on it.

A physician who directly takes the life of a patient commits a criminal offense even if the patient desires to
die. A physician would be regarded as the agent of a patient's death if she administered medication or
other medical procedures with the intent or knowledge that the patient would die. Thus, the administration
of a lethal injection is a crime irrespective of the patient's wishes, quality of life or prognosis. Non-
physicians have been convicted of criminal homicide for injections of a fatal dose of licit or illicit drugs at the
request of the person. A physician's license to practice medicine would not excuse her from liability in such
circumstances. A physician who actively participates in the act of causing death, such as by placing the
lethal dose of medication in the patient's hand or mouth, risks prosecution for murder or manslaughter. The
physician would not be considered to be assisting suicide under a state statute providing for a lesser
offense.

CURRENT STATUS OF EUTHANASIA IN THE PHILIPPINES

Euthanasia is illegal in the Philippines. In 1997, the Philippine Senate considered passing a bill legalizing
passive euthanasia. The bill met strong opposition from the country's Catholic Church. If legalized the
Philippines would have been the first country to legalize euthanasia. Under current laws, doctors assisting a
patient to die can be imprisoned and charged with malpractice.

PROS AND CONS OF EUTHANASIA

 Right to Die
- PRO: "The right of a competent, terminally ill person to avoid excruciating pain and embrace a timely and
dignified death bears the sanction of history and is implicit in the concept of ordered liberty. The exercise of
this right is as central to personal autonomy and bodily integrity as rights safeguarded by this Court's
decisions relating to marriage, family relationships, procreation, contraception, child rearing and the refusal
or termination of life-saving medical treatment. In particular, this Court's recent decisions concerning the
right to refuse medical treatment and the right to abortion instruct that a mentally competent, terminally ill
person has a protected liberty interest in choosing to end intolerable suffering by bringing about his or her
own death. A state's categorical ban on physician assistance to suicide -- as applied to competent,
terminally ill patients who wish to avoid unendurable pain and hasten inevitable death -- substantially
interferes with this protected liberty interest and cannot be sustained."

- CON: "The history of the law's treatment of assisted suicide in this country has been and continues to be
one of the rejections of nearly all efforts to permit it. That being the case, our decisions lead us to conclude
that the asserted 'right' to assistance in committing suicide is not a fundamental liberty interest protected by
the Due Process Clause."

 Patient Suffering at End of Life

- PRO: "At the Hemlock Society we get calls daily from desperate people who are looking for someone
like Jack Kevorkian to end their lives which have lost all quality... Americans should enjoy a right
guaranteed in the European Declaration of Human Rights -- the right not to be forced to suffer. It
should be considered as much of a crime to make someone live who with justification does not wish to
continue as it is to take life without consent."
- CON: "Activists often claim that laws against euthanasia and assisted suicide are government
mandated suffering. But this claim would be similar to saying that laws against selling contaminated
food are government mandated starvation. Laws against euthanasia and assisted suicide are in place
to prevent abuse and to protect people from unscrupulous doctors and others. They are not, and never
have been, intended to make anyone suffer."
 Slippery Slope to Legalized Murder
- PRO: "In a society as obsessed with the costs of health care and the principle of utility, the dangers of
the slippery slope... are far from fantasy... Assisted suicide is a half-way house, a stop on the way to
other forms of direct euthanasia, for example, for incompetent patients by advance directive or suicide
in the elderly. So, too, is voluntary euthanasia a half-way house to involuntary and non voluntary
euthanasia. If terminating life is a benefit, the reasoning goes, why should euthanasia be limited only to
those who can give consent? Why need we ask for consent?"
 - CON: "Especially with regard to taking life, slippery slope arguments have long been a feature of the
ethical landscape, used to question the moral permissibility of all kinds of acts... The situation is not
unlike that of a doomsday cult that predicts time and again the end of the world, only for followers to
discover the next day that things are pretty much as they were...   We need the evidence that shows
that horrible slope consequences are likely to occur. The mere possibility that such consequences
might occur, as noted earlier, does not constitute such evidence."
 Hippocratic Oath and Prohibition of Killing
- PRO:  "Over time the Hippocratic Oath has been modified on a number of occasions as some of its
tenets became less and less acceptable. References to women not studying medicine and doctors not
breaking the skin have been deleted. The much-quoted reference to 'do no harm' is also in need of
explanation. Does not doing harm mean that we should prolong a life that the patient sees as a painful
burden? Surely, the 'harm' in this instance is done when we prolong the life, and 'doing no harm' means
that we should help the patient die. Killing the patient--technically, yes. Is it a good thing--sometimes,
yes. Is it consistent with good medical end-of-life care: absolutely yes."
- CON: "The prohibition against killing patients... stands as the first promise of self-restraint sworn to in
the Hippocratic Oath, as medicine's primary taboo: 'I will neither give a deadly drug to anybody if asked
for it, nor will I make a suggestion to this effect'... In forswearing the giving of poison when asked for it,
the Hippocratic physician rejects the view that the patient's choice for death can make killing him right.
For the physician, at least, human life in living bodies commands respect and reverence--by its very
nature. As its respectability does not depend upon human agreement or patient consent, revocation of
one's consent to live do not deprive one's living body of respectability. The deepest ethical principle
restraining the physician's power is not the autonomy or freedom of the patient; neither is it his own
compassion or good intention. Rather, it is the dignity and mysterious power of human life itself, and
therefore, also what the Oath calls the purity and holiness of life and art to which he has sworn
devotion."
  Government Involvement in End-of-Life Decisions
- PRO: "We'll all die. But in an age of increased longevity and medical advances, death can be
suspended, sometimes indefinitely, and no longer slips in according to its own immutable timetable. So,
for both patients and their loved ones, real decisions are demanded: When do we stop doing all that we
can do? When do we withhold which therapies and allow nature to take its course? When are we,
through our own indecision and fears of mortality, allowing wondrous medical methods to perversely
prolong the dying rather than the living? These intensely personal and socially expensive decisions
should not be left to governments, judges or legislators better attuned to highway funding."
- CON: "Cases like Schiavo's touch on basic constitutional rights, such as the right to live and the right
to due process, and consequently there could very well be a legitimate role for the federal government
to play. There's a precedent--as a result of the highly publicized deaths of infants with disabilities in the
1980s, the federal government enacted 'Baby Doe Legislation,' which would withhold federal funds
from hospitals that withhold lifesaving treatment from newborns based on the expectation of disability.
The medical community has to have restrictions on what it may do to people with disabilities - we've
 already seen what some members of that community are willing to do when no restrictions are in
place."

 Palliative (End-of-Life) Care

- PRO: "Assisting death in no way precludes giving the best palliative care possible but rather
integrates compassionate care and respect for the patient's autonomy and ultimately makes death with
dignity a real option... The evidence for the emotional impact of assisted dying on physicians shows
that euthanasia and assisted suicide are a far cry from being 'easier options for the caregiver' than
palliative care, as some critics of Dutch practice have suggested. We wish to take a strong stand
against the separation and opposition between euthanasia and assisted suicide, on the one hand, and
palliative care, on the other that such critics have implied. There is no 'either-or' with respect to these
options. Every appropriate palliative option available must be discussed with the patient and, if
reasonable, tried before a request for assisted death can be accepted... Opposing euthanasia to
palliative care... neither reflects the Dutch reality that palliative medicine is incorporated within end-of-
life care nor the place of the option of assisted death at the request of a patient within the overall
spectrum of end-of-life care."
- CON: "Studies show that hospice-style palliative care 'is virtually unknown in the Netherlands [where
euthanasia is legal].' There are very few hospice facilities, very little in the way of organized hospice
activity, and few specialists in palliative care, although some efforts are now under way to try and jump-
start the hospice movement in that country... The widespread availability of euthanasia in the
Netherlands may be another reason for the stunted growth of the Dutch hospice movement. As one
Dutch doctor is reported to have said, 'Why should I worry about palliation when I have euthanasia?'
   Social Groups at Risk of Abuse
- PRO: "One concern has been that disadvantaged populations would be disproportionately
represented among patients who chose assisted suicide. Experience in Oregon suggests this has not
been the case. In the United States, socially disadvantaged groups have variably included ethnic
minorities, the poor, women, and the elderly. Compared with all Oregon residents who died between
January 1998 and December 2002, those who died by physician-assisted suicide were more likely to
be college graduates, more likely to be Asian, somewhat younger, more likely to be divorced, and more
likely to have cancer or amyotrophic lateral sclerosis... Moreover, although 2.6 percent of Oregonians
are African American, no African American patients have chosen assisted suicide."
- CON: "It must be recognized that assisted suicide and euthanasia will be practiced through the prism
of social inequality and prejudice that characterizes the delivery of services in all segments of society,
including health care. Those who will be most vulnerable to abuse, error, or indifference are the poor,
minorities, and those who are least educated and least empowered. This risk does not reflect a
judgment that physicians are more prejudiced or influenced by race and class than the rest of society -
only that they are not exempt from the prejudices manifest in other areas of our collective life.
While our society aspires to eradicate discrimination and the most punishing effects of poverty in
employment practices, housing, education, and law enforcement, we consistently fall short of our goals.
 The costs of this failure with assisted suicide and euthanasia would be extreme. Nor is there any
reason to believe that the practices, whatever safeguards are erected, will be unaffected by the broader
social and medical context in which they will be operating. This assumption is naive and
unsupportable."

 Religious Concerns
- PRO: "The primary opposition to the idea that terminally ill, mentally competent people should be able
to choose to hasten death with medical assistance often comes from religious sources, primarily the
Catholic hierarchy and, more recently, the right-to-life movement. Although the legal battle over the law
has hinged on physicians' right to prescribe life-ending drugs which fall within the federal Controlled
Substances Act (CSA), the underlying fight has been between what one side sees as the dying
individual's right to a humane and compassionate death and the other as interference with God's plan.”
- CON:  "As Catholic leaders and moral teachers, we believe that life is the most basic gift of a loving
God- a gift over which we have stewardship but not absolute dominion. Our tradition, declaring a moral
obligation to care for our own life and health and to seek such care from others, recognizes that we are
not morally obligated to use all available medical procedures in every set of circumstances. But that
tradition clearly and strongly affirms that as a responsible steward of life one must never directly intend
to cause one's own death, or the death of an innocent victim, by action or omission”
 Living Wills
- PRO: "Living wills can be used to refuse extraordinary, life-prolonging care and are effective in
providing clear and convincing evidence that may be necessary under state statutes to refuse care
after one becomes terminally ill. A recent Pennsylvania case shows the power a living will can have. In
that case, a Bucks County man was not given a feeding tube, even though his wife requested he
receive one, because his living will, executed seven years prior, clearly stated that he did 'not want tube
feeding or any other artificial invasive form of nutrition'... A living will provides clear and convincing
evidence of one's wishes regarding end-of-life care."
- CON: "Not only are we awash in evidence that the prerequisites for a successful living wills policy are
unachievable, but there is direct evidence that living wills regularly fail to have their intended effect...
When we reviewed the five conditions for a successful program of living wills, we encountered
evidence that not one condition has been achieved or, we think, can be. First, despite the millions of
dollars lavished on propaganda, most people do not have living wills... Second, people who sign living
wills have generally not thought through its instructions in a way we should want for life-and-death
decisions... Third, drafters of living wills have failed to offer people the means to articulate their
preferences accurately... Fourth, living wills too often do not reach the people actually making decisions
for incompetent patients... Fifth, living wills seem not to increase the accuracy with which surrogates
identify patients' preferences."

POSSIBLE ARGUMENTS OF THE NEGATIVE SIDE

 “Euthanasia is nothing more than legalized murder.”
 People on both sides of the debate care about suffering people and want to prevent intolerable
suffering. The key issue is the long-term consequences of a law change for public safety. This
is an issue of social justice – protecting vulnerable people from pressure and abuse.
 These days no-one need die in pain. In the rare cases (1-4%) where pain medication is not
enough, a person can be sedated. Persistent requests for euthanasia are not based on pain,
but on non-physical reasons such as a desire to be in control, a fear of being a burden or
feeling socially isolated. Death is not the right or best response to these issues.
 The fact that voluntary euthanasia and assisted suicide (EAS) are illegal means maximum
efforts are made to relieve pain and address all aspects of a person’s suffering. Will this still
occur if the law is changed? EAS would be a cheaper option.
 Legalizing EAS, especially for irreversible and unbearable mental conditions, accepts that
‘some suicides are OK’. This risks sending a ‘mixed message’ regarding the tragedy of youth
suicide and creates a confusing double standard.
 The current law has a stern face, but a kind heart. By holding a penalty in reserve, it sends a
strong message that it’s not OK to deliberately kill someone else. However, the Court shows
compassion in individual cases based on specific circumstances. For example, in 2012 Evans
Mott was discharged without conviction for assisting his wife’s suicide.
 Changing the law will not mean an end to such cases going to court as it could still be difficult
to distinguish between an assisted suicide and a murder.
 Many assume that changing the law will simply allow the very small number of high-profile
cases to proceed without legal objection. In fact, ‘legalization leads to normalization’ and, as
has happened overseas, will lead to greatly increased numbers dying that way.
 Changing the law would create a legal situation in which the state licenses death in advance
and sanctions the death of some of its citizens.
 Legalising assisted suicide amounts to state-sanctioned suicide.
 Changing the law would send a message that some people’s lives are not worth living – it will
steer some people towards a premature death.
 Granting a tiny and vocal minority the choice to be killed will undermine the choice and/or will
of many others to live.
 Allowing voluntary euthanasia and assisted suicide (EAS) opens the door for disabled, sick
and elderly people to see themselves as a financial and emotional burden. The ‘right to die’
could become a ‘duty to die’. No safeguards can protect against this. In Oregon, 40% of those
receiving legal assisted suicide in 2014 cited “being a burden” as a reason.
 Abuse of disabled and elderly people is a serious issue in New Zealand. Legalizing euthanasia
would put them further at risk, especially when there is increasing pressure on the health
budget.
 We should not ask doctors, who have a duty of care, to intentionally kill their patients using
lethal drugs.
 Intentional killing is dangerous and opens the door to abuse. Legalizing voluntary euthanasia
paves the way for euthanasia without consent. Up to a third of Belgian euthanasia cases occur
without consent.
  Safeguards will be unenforceable, because they rely totally on the agents involved to report
the death as assisted suicide or euthanasia. There is no way of knowing whether a person
followed all the legal requirements.
OTHER POSSIBLE ARGUMENTS AND REBUTTALS

 Firstly, the financial costs of keeping a person on a life support machine are enormous, not to
mention hospital bills and 24-hour medical care. 80% of the Filipinos live in poverty, how many
people can afford this? What happens then if the family cannot afford keeping the relative on
life support? Do they get arrested? Secondly, the emotional distress that is caused by seeing
your loved one in a vegetative state for an extended period of time while doctors continually tell
you that there is no hope for recovery is potentially traumatizing. Some people who consider
this as suffering for the vegetable loved one will want euthanasia, but they haven't the option.
Legalizing this will not force everyone to take this course, but rather only provide an option.
Lastly, the medical facilities and time that is devoted towards the vegetative patient with low
chances of recovery could be spent helping someone else in greater need. Already in the
Philippines we have a shortage of medical personnel and equipment, this additional burden will
only cause more damage.

 One of the big arguments against euthanasia is that it’s irreversible: Once the patient is gone,
we’ll never know if their unexpected recovery was just around the corner, or if they might have
gone on to lead full and happy lives despite their illness. However, this argument ignores the
data so hard it basically punches reason in the face. The fact is, in all nations where
euthanasia is legal, it’s the near-exclusive preserve of the terminally ill. And, despite what
hopeful evangelicals and daytime dramas would have us believe, terminal illness is usually
exactly that: the final stop before death. In 1991, a Dutch report into euthanasia found that
in 86 percent of cases, euthanasia shortened life by a maximum of a week and usually only a
few hours. In other words, it was a last resort—an escape hatch used by patients in
unbearable agony who would rather that agony ended now than in two days’ time. Now, this
isn’t to say that miracle recoveries never happen: They occasionally do. But the reason you
hear about them is because they’re so statistically improbable. For the vast majority of
patients, such a recovery is less likely than winning the lottery and getting struck by lightning in
the same afternoon.

 In 2005, a study by the New England Journal of Medicine found that only 0.4 percent of all
euthanasia procedures were carried out without the patient’s explicit permission. You might
argue that that’s 0.4 percent too many, but get this: A 1991 report—written a decade before
euthanasia was legalized—put the number at 0.8 percent. In other words, giving a nationwide
go-ahead for doctors to legally end their patient’s lives actually halved the number of unwanted
deaths. n Britain, a 2012 study discovered that as many as 57,000 patients each year die
without being told that efforts to keep them alive have been stopped. Instead, they’re just
shoved onto a “death pathway” designed to alleviate suffering without ever being told. So
basically, doctors in the UK are already practicing euthanasia—only without any of the legal
framework to check abuses that would come from legalizing it.
 Most people would be shocked to think economics factored into their life-or-death decisions,
and rightly so. However, there’s no getting around how absurdly expensive end-of-life care is in
America: According to CNN, one in every four Medicare dollars spent goes to the five percent
of beneficiaries in the last year of their life. The upshot of this is often crippling debt for the
families of terminally ill patients, with the care of a single individual at the end of their life
costing an estimated $39,000. For 40 percent of households, the bill exceeds their financial
assets. This might be acceptable if end-of-life care was worth the money, but it’s objectively
not. Doctors will readily attest to the ability of modern medicine to slightly prolong life—at the
cost of totally destroying its quality. If you can’t be bothered to read that last link, I’ll sum it up
here: End-of-life care is often brutal, nasty, traumatic, and very expensive, putting patients
through long stretches of unnecessary suffering just to give them an extra month or two. And
when the terminally ill patient undergoing these nasty, expensive treatments has repeatedly
insisted that they’d rather be dead, you have to start wondering who all this expenditure is
really benefiting.

 Most of us fear death, but a large part of that fear comes from uncertainty and the worry that it
might be preceded by agonizing pain (like a car wreck, say). If we knew exactly when we were
going to die—and knew for a fact it would be painless—it’s a fair bet that fear would simply
melt away. By allowing people to choose the how and when of their death, we’re guaranteeing
they’ll live what remaining life they have to the fullest, free from the pain of anxiety.

“As I have said, I would like to die peacefully with Thomas Tallis on my iPod before the
disease takes me over and I hope that will not be for quite some time to come, because if I
knew that I could die at any time I wanted, then suddenly every day would be as precious as a
million pounds. If I knew that I could die, I would live. My life, my death, my choice.” (Terry
Pratchet, an author diagnosed with Alzheimer’s Disease)

 When we think about death, most of us imagine passing serenely away surrounded by our
loved ones. But death isn’t like that. Death is usually slow, painful, and undignified. And by
refusing people the “right” to end their own lives, we’re increasing that pain and indignity to a
horrifying extent. In the case of Tony Nicklinson. In 2010 and again in 2012, his bid to die was
rejected by the British High Court. As a sufferer of “locked in” syndrome, Tony was incapable
of moving a single muscle in his body—a condition he described as “a living nightmare.”
Unable to do the job himself and unable to ask anyone to do it for him, Tony followed the only
course of action available: He starved himself to death. After a week without food, he died in
“indignity and misery” from pneumonia.

 A final myth is that legalizing assisted dying will open the floodgates, leading to a murder-
happy world where life is cheap and death is easy. But analysis of the data shows that this isn’t
the case. Let’s bounce back to the Netherlands for a moment: Every year, roughly 3,000 Dutch
people seek to be euthanized. That sounds like a lot, until you realize it accounts for only  1.7
percent of all deaths. And application is no guarantee of acceptance, either. Far from making
death cheap, the Netherlands’ system of assisted dying has made it complex, bureaucratic,
and very difficult to achieve. Around two-thirds of patients who apply to be euthanized are
refused; while euthanasia itself remains a criminal act unless carried out by a qualified doctor
with the consent of a legal and an ethics expert. In short, getting your doctor to relieve your
 suffering even in the liberal Netherlands is nigh-on impossible—hardly the sort of trigger-happy
climate pundits would have you believe it was.

 The famous maxim “do no harm” is a summation of the Hippocratic Oath—an ancient code
designed to guide doctors in their actions. Many people interpret this to mean “do nothing to
harm the patient’s chances of survival.” But, taken literally, it could just as easily mean “don’t
artificially keep someone alive when death is preferable.” It all comes down to what we believe
constitutes “harm.” When a patient is in intense pain or suffering severe mental anguish, our
society could be doing more harm by keeping them alive than allowing them to die. In extreme
cases, such as those of Tony Nicklinson it could be argued that any physician
who didn’talleviate their suffering when asked was violating the principles of their oath—and
allowing both great harm and a great injustice to occur on their watch. At the end of the day,
it’s up for us to decide whether we can sit back and watch people suffer, or choose to do
something about it. Until we make up our minds, that suffering will continue.

PRAGMATIC AND ETHICAL ARGUMENT ON EUTHANASIA

There are two main types of argument used to support the practices of euthanasia and assisted suicide.
They are the: 
1. ethical argument – that people should have freedom of choice, including the right to control their
own body and life (as long as they do not abuse any other person’s rights), and that the state
should not create laws that prevent people being able to choose when and how they die
2. pragmatic argument – that euthanasia, particularly passive euthanasia, is allegedly already a
widespread practice, just not one that people are willing to admit to, so it is better to regulate
euthanasia properly
Ethical Argument:
The ethical argument states that everyone should be able to choose when and how they want to
die, and that they should be able to do so with dignity . The concept of "quality of life" is an important aspect
of this argument. The idea put forward as part of the religious argument against euthanasia and assisted
suicide – that life is sacred and is therefore always better than death – is rejected. The ethical
argument suggests that life should only continue as long as a person feels their life is worth living.

For example, someone who supports the use of euthanasia or assisted suicide based on the ethical
argument may believe that a person should be able to choose to end their life if they are living in intolerable
pain and their quality of life is severely diminished.
Pragmatic Argument:
The pragmatic argument states that many of the practices used in end of life care are a type of
euthanasia in all but name. For example, there is the practice of making a "do not attempt cardiopulmonary
resuscitation" (DNACPR) order, where a person requests not to receive treatment if their heart stops
beating or they stop breathing. Critics have argued that DNACPR is a type of passive euthanasia, because
a person is denied treatment that could potentially save their life.
Another controversial practice is known as palliative sedation. This is where a person who is experiencing
extreme suffering, for which there is no effective treatment, is put to sleep using sedative medication.
Palliative sedation is often used to treat burns victims who are expected to die.
While palliative sedation is not directly carried out for the purpose of ending lives, many of the sedatives
used carry a risk of speeding up death. Therefore, it could be argued that palliative sedation is a type of
active euthanasia.

The pragmatic argument is that if euthanasia in these forms is being carried out anyway, society might as
well legalize it and ensure that it is properly regulated. It should be stressed, however,  that the above
interpretations of DNACPR and palliative sedation are very controversial and are not accepted by most
doctors, nurses and palliative care specialists.

ESSAYS ON LEGALIZING EUTHANASIA

It’s been six months since your grandfather, once an active and joyful man, has been diagnosed
with Amyotrophic Lateral Sclerosis (ALS), or Louis Gehrig’s disease. The effects of the disease are
beginning to take their toll on him and now with his limited motor skills, he has recently been confined to a
wheelchair. The doctors tell your family that he has less than two years to live and that the disease will get
progressively worse as time passes. Your grandfather, who is a dignified man, has been asking for assisted
suicide, euthanasia, but it isn’t allowed where you live. It’s cases like these where you begin to wonder why
euthanasia has yet to be legalized in the majority of the world. Shouldn’t everyone have the right to a
dignified death or should terminally ill patients be left to suffer? And yet, assisted suicide remains legal in
only three of the fifty states: Oregon, Washington, and Montana; and four countries: Belgium, Netherlands,
Luxembourg, and Albania. Is this right, is this ethical, or are we depriving others of a personal right of
choice? In order to end the physical suffering of terminally ill patients, leave families of terminally ill patients
in better financial situations, and above all else provide emotional and psychological relief to a dying person
with a low quality of a life, euthanasia should be legalized. 

Now when you think about the physical pain someone with Hepatitis B, pancreatic cancer, or another
terminal disease experiences on a daily basis it just seems inhumane not giving them a choice of death
over a life of suffering. It’s simple when someone is endlessly suffering, unable to move, feed themselves,
and even breathe on their own that they should be entitled to euthanasia. After all, why should someone
who’s terminally ill, who has been living permanently in a hospital also have to watch their loved ones
suffering along beside them? For the ill patient watching family and friends suffering along with them only
makes the ordeal even harder to bear. Yet the aspect of both physical and mental suffering is not enough
to legalize euthanasia. Although at first the financial well-being of the family of a terminally ill patient may
not seem like a legitimate reason to legalize euthanasia, it is in fact another pro. Believe it or not, the
average cost per day of keeping someone in the Intensive Care Unit (ICU) alive is $10,000. For families of
a dying loved one this can lead to great amounts of debt. Just think about it, keeping someone on life
support for a month will cost roughly $300,000; that’s $300,000 that could have been used for something
else. Despite the initial reaction that money should not be taken into consideration for a human life, the
truth of the matter is that in our world today this has become a reality. Life support extends the lives of
those who without machines would have died naturally so isn’t it better to perhaps donate that money to a
foundation that aids in finding a cure for a disease rather than keeping a terminally ill patient alive on a
machine? The patient would never want all of this money spent on them if there truly was no hope, no cure.

It is simply prolonging the inevitable from happening.

Lastly, shouldn’t the right to a dignified death be given to everyone; why not, when it’s someone’s freedom
of choice? Just like we have the freedom to express ourselves and practice, if any, religion that we choose,
the same should go for death. As the saying goes, “When it’s your time to go, it’s your time to go.” Do you
see what we’ve already done as a society, going against nature, keeping people alive who technically
shouldn’t be? The least you can give someone who has already experienced so much pain and suffering is
a dignified exit from this world and euthanasia can give them exactly that. It’s the patient’s choice, just like
we respect others’ decisions in life, when it comes to death the same applies.
---
 On the other side of the debate, there is a strong argument that people should have the right to terminate
their lives, whenever, and however they may wish. Many supporters of voluntary euthanasia believe that everyone
has the right to control their body and life, and should be free to decide at what time, and in which manner they will
die. The idea behind this is that unnecessary restraints on human rights should be avoided. It was said in an article in
the Independent newspaper in March 2002, that; “In cases where there are no dependants who might exert pressure
one way or the other, the right of the individual to choose should be paramount. So long as the patient is lucid, and
his or her intent is clear beyond doubt, there need be no further questions." Since the right to life gives a person the
right to not be killed if they do not want to, proponents of euthanasia argue that respect for this right will prevent
euthanasia being misused, as killing a patient without their permission would violate their human rights. It can also be
argued that because death is a private matter, if there is no harm to any other people, there is no right to deny
someone‘s wish to die. Supporters of this believe that if euthanasia promotes the best interests of all the parties
concerned, and no human rights are violated, then it is morally acceptable for voluntary euthanasia to take place.

Another argument against euthanasia, this time a practical one, is that euthanasia is not needed when proper
palliative care is available. Terminally ill patients are given drugs and other types of support to help relieve the
physical pain and mental effects of being terminally ill. If this palliative care is competent then it may be able to
relieve the patient of a lot of pain and discomfort, and will give the patient a better quality of life. It has been stated by
the World Health Organization 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." Not all of the trauma experienced by a patient is physical however, and drugs alone cannot
relieve the emotional pain felt by someone counting the days until their death, although the emotional support that
can be provided from palliative care can go a long way to make the last part of a terminally ill patients life less
emotionally stressful. Effective palliative care will give the patient and their loved ones chances to spend quality time
together, and will allow the patient to live the remaining part of their lives with as much of the distress and pain felt by
a terminally ill patient removed as possible. Some argue, however, that along with the introduction of euthanasia,
there could be a reduction in the availability of palliative care, as euthanasia is more cost effective than prolonging
the life of dying patients. This could possibly reduce the availability of care for terminally ill patients who do not wish
to be euthanized. Sometimes, however, palliative care is not enough for some patients whose lives are just too
unbearable, so could the termination of their lives be the best option? Some supporters of the legalization of
euthanasia have put forward another point; they argue that if we can place aside the notion that death can in no way
be something positive, we are able to consider that it can in certain cases be a better option than keeping a patient
that is in terrible pain and discomfort alive. If death is not always seen to be the worst outcome, then many of the
objections to euthanasia no longer exist, since many of the arguments rely on the notion that death cannot be a good
outcome. People generally avoid death because they enjoy and value being alive, but in the case of a terminally ill
patient, they may be in a lot of discomfort and pain, and are unable to enjoy their life. This may cause the patient to
devalue their life, and the patient may decide that they do not wish to endure their suffering any longer. There is also
the fact that although the patient themselves may wish to be euthanized, it may have a very detrimental effect on the
family of the patient. Those in favor of this argument believe that since the death of a patient in that situation could be
a better option to keeping them alive; the patient’s wish should be respected.
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It is apparent that euthanasia should be permitted everywhere for the following reasons: individual liberty;
one s undesired pain, suffering, and misery; and the individual s frustration from having a valueless life. First of all,
one should be able to understand the term euthanasia. In ancient Greece, eu thanatos meant easy death. Today s
euthanasia generally refers to mercy killing, the voluntary ending of the life of someone who is terminally or
hopelessly ill. Knowing that, it is seemingly appropriate to say that one has the right to die an easy death if, and only
if, he is terminally ill. Otherwise, different situations should not play any part in this issue. To understand more about
the pro-euthanasia side of this issue, it is best conceived through the viewpoints, strong beliefs, and perspectives of
proponents of euthanasia.

An individual has liberty, which includes the right of owning his life. He is the possessor of his life. Just as he can do
whatever he wishes with his possessions, such as selling his new house, he can also wish to discontinue his life if
the reasons were rational. In a typical situation, a person has some terrible, deadly disease. He is trapped in a
hospital bed, with all sorts of medical equipment connected to him, unable to move or do much of anything except
exist. He is in terrible pain; he begs to have these machines disconnected so he can go home and live out whatever
life he has left and die in peace. He does not want to endure the pain, but instead, to assuage it. However, the
doctors refuse because to turn off the machines would surely result in his death, and they have a presumed bias
against doing this. If a person decides that he wants to die, and someone does not think that this is a good decision,
what right does the opposing person have to tell him that he cannot do this? It is clear that a patient s decision to ask
for a cessation in treatment, reflecting his own preference for death rather than for a continuation of discomfort or
suffering, must be respected, barring exceptional circumstances. Therefore, that individual s decision should be
carried out because he has that right to his own personal decision, which is only one of many reasons why
euthanasia should be legalized. In addition, one should have the right to end his life by euthanasia because of the
unsolicited pain, suffering, and misery he feels due to the disease he has or the condition he is in. People in this
position would most likely want to alleviate their pain, suffering, and depression just to name a few partially because
of the inconveniences, emotional and physical burdens, and drawbacks imposed on family members, relatives, and
friends. Furthermore, family members may be sensitive to the costs accumulating during terminal care.
Consequently, patients may feel guilty in this entire ordeal. Even more, people who, maybe because of a serious
illness, are extremely depressed partly because they want to live their lives to the fullest by perhaps participating in
energetic and active events but know that that is not possible now that they are severely ill and sick. Since they
recognize that enjoying life in those ways is no longer possible, they may want an easy way out euthanasia. Others
simply do not want to sustain suffering. Everybody has different amounts of pain and suffering that he/she can
tolerate. In considering suffering of terminal patients, one cannot exclude from thought the grief due to distress, fear,
and agony. Nor must anyone underestimate the bearable level of pain in the periods between doses of medication or
simply from being turned over in bed. There is still too little known about what is actually experienced by patients as
they approach death so it is evident that the individual, and only the individual, has the right to choose when he wants
to die. These factors, along with unwanted suffering, pain, and misery are only some of the components considered
in allowing the act of euthanasia.

The final element worthy of discussion in legalizing euthanasia is an individual s frustration in living, in his opinion, a
valueless life after becoming critically ill. People who suffer from illnesses that make them unable to communicate do
not want to live any longer. This includes people who are in a coma, are paralyzed, or simply so sick and weak that
they cannot make meaningful sounds or other communication. If the person is no longer able to relate in any way to
his relatives and friends, he might not want to live a day further (Bender 28). In addition to that, some people believe
that their quality of life is so low that they would rather die. If this is the case, then what position do others have to go
against this? No one other than the patient has any right to deny the patient his way of dying. Therefore, euthanasia
should and must be a legal choice.

Like any other issue, there are opposing viewpoints regarding the legalization of euthanasia. Pro-lifers, people who
are against euthanasia, place the emphasis on killing. They believe that we are merely stewards of our lives; it is for
God to decide when our lives are to end. Further, suffering, is an inevitable part of life; our task is to understand and
grow from suffering, not evade it. Pro-euthanasia people, who place the emphasis on mercy, argue that stewardship
has not prevented the religious from exercising control in other areas of their lives for example, in using analgesics
for surgery and childbirth. If it is for God to decide when life will end, if suffering is ennobling, then the very practice of
medicine is and always has been wrong. Further, they hold that theological arguments against euthanasia pertain
only to the religious; the constitutional separation of church and state requires that opposition to euthanasia on
theological grounds alone not be codified in law. Therefore, the counter-argument against euthanasia was
objectionable and absurd. In our increasingly secular society, many believe that humans are sovereigns, not
stewards, of their own lives. For them, it follows that respect for autonomy should mean respect for a person s
decision to end his or her life. How can we demand that someone endure unbearable pain just so that we can be
morally comfortable? Other arguments facing this issue focus on medical grounds. Critics say that diagnosis can be
wrong. Furthermore, a cure for what is today incurable might be found tomorrow. And what of informed consent? Can
a patient struggling with pain and the enormity of death make a truly rational decision to end his or her life? Pro-
euthanasia people debate that diagnoses can be wrong, but for the most part they are very accurate, especially when
disease is so far advanced that euthanasia is discussed. At that stage death will not be held off even if a miracle cure
is found. Proponents of legalizing euthanasia respect the trust that springs from the physician-patient relationship.
But they feel sure that that essential trust can be protected by establishing tight procedures to ensure that euthanasia
is not abuse. Just as before, the pro-lifers are proven wrong.

Individual liberty, undesired misery, pain, and suffering, and one s frustration in having a worthless life all serve as
critical circumstances to be considered thoroughly in legalizing the act of euthanasia everywhere. Euthanasia is a
death option that should not raise controversy if performed solely in the appropriate predicaments mentioned earlier.
Knowing this, shouldn’t t euthanasia be legalized? The solution to that question would have to be yes. Coming to an
end, the crux of this matter is summarized in one simple sentence: The emphasis of euthanasia should be placed on
the purpose of the act, not the nature of the act.

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