ANSHU

PHI/19/46

Euthanasia:
Euthanasia is also called as mercy killing , it is the act of putting to death painlessly or allowing to die, as
by withholding extreme medical measures, a person or animal suffering from an incurable, especially a
painful, disease or condition.

Types of euthanasia:
Euthanasia has been categorized into four parts as follows:

1. ACTIVE EUTHANASIA:

It refers to the physician deliberate act, usually the administration of lethal drugs, to end an incurably or
terminally ill patient’s life.

2. PASSIVE EUTHANASIA:

It is when death is brought about by an omission, i.e. when someone lets the person die. This
can be done by withdrawing or withholding the treatment. For example by switching off a
machine that is keeping a person alive, so that they die of their disease.

3. VOLUNTARY EUTHANASIA:

It refers to a situation where a person’s life is ended at their request in order to relieve them of
suffering.

4. NON-VOLUNTARY EUTHANASIA:

It 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.

Arguments for Euthanasia:

1. Autonomy

The argument from autonomy is based on the claim that every person has the right to shape
their own life through their choices and that must include, certainly under the unfavorable
circumstances of pain or disability or we could simply say the right to choose the time and
circumstances of our own deaths. This principle is an expression of the essentially Kantian idea
that what is paramount importance for my life is that it consists of my own choices, for good
 or ill. For Kant, person should be treated as ends in themselves. It is never permissible to treat
them as a means, even if it involves attempting to us them as a means to their own well being.
Treating someone as a means to their own wellbeing would involve the dubious assumption
that someone other than that person might know better than they in what this wellbeing
might consist. Mill too defended this right to determine one’s own destiny autonomously, and
to be free from heteronymous determination by others. Heteronomy refers to action that is
influenced by a force outside the individual, in other words the state or condition of being
under sway of another. This right is implicit in mill’s famous ‘harm’ principle:

The only purpose for which power can be rightfully exercised over any member of a civilized
community, against their will, is to prevent harm to others. His own good, either physical or
moral, is not sufficient warrant...

Mankind are greater gainer by suffering each other to live as seems good to themselves than
by compelling each to live as seems good to the rest....

Taking autonomy seriously means acknowledging individual sovereignty over all purely self
regarding acts. Like any other self-regarding act, it should be exempted from interference of
others. Both Kant and Mill thought that other people taking control of one’s life was an
intolerable intrusion. In the spirit of Kant and Mill, Bob Dent clearly regarded Kevin Andrews’s
proposal to limit the freedom of individuals to seek medical assistance to end their intolerable
life, as an insufferable impertinence.   

2. Beneficence and Fairness

There are 3 related arguments to support a right to determine the circumstances of one’s own
death .i.e. corollaries of harm principle.

First, “do as you would be done” (KANT) requires that we provide aids to those in distress and
provide appropriate relief from suffering.                                                                                                            In
case where palliation (relief of symptoms and suffering caused by cancer and other life
threatening diseases. Palliation helps a patient feel more comfortable and improves the
quality of life, but does not cure the disease.)is ineffective, it would be unreasonable and
unconscionable to deny the right to make a dignified end to their suffering.

Secondly, denial of right to die is unfair and cruel; no one should be obliged to endure
unbearable suffering.

Thirdly, the denial of right to die amount to imposing a ‘duty to live’-no matter what the abject
(humiliating) condition of that life might be. This imposition is presumptuous (inappropriate)
and intolerable.

              

Argument against Euthanasia

1. slippery slope or the wedge argument (thin end of the wedge)

The most commonly articulate worry is that if euthanasia is admitted for deserving cases, this
would lead to the admission of less deserving or quite inappropriate cases. In time, the principle
would be progressively extended while the safeguards become diluted and weakened. And soon a
policy motivated by compassion will become a vehicle for abuse and monstrous injustice. As we
are not aware where to put a wedge, which can lead to exploitation of patients by the family or
the physician.

This alarmist rhetoric (the art of effective or persuasive speaking) is unpersuasive. Any overt
practice of euthanasia will attract the closest scrutiny. So, it is difficult to imagine safeguards being
eroded without vigorous public opposition. F.M. comford’s assessment of wedge argument sums it
as, “the principle of wedge is that you must not act justly now for the fear of raising expectations
that you may act still more justly in the future.

The answer to wedge argument here is not to forbid just practice, but to take careful step to
ensure that regulations and safeguards were developed to guarantee that the line between
voluntary and non-voluntary acts of euthanasia will not be transgressed.

2. over practice of euthanasia would change the culture of medicine

The second argument used by opponents of euthanasia is that the practice of euthanasia
changes the culture of medicine. Instead of sustaining and nurturing life, medical practice
would come to include the deliberate killing of patients. Doctors it is said should be healers,
not killers. One response to this is to point out first that compassionately motivated killing has
become a surprising common part of medical practice. What need to be done is to turn an
unregulated procedure, into a pattern of practice which is both safe and just.                                     
In the age of sophisticated life-sustaining technology some elements of Hippocratic oath, such
as the injustice to preserve life at all costs, have passes their use-by date. Contemporary
medical circumstances demand that the physician’s duty of care and beneficence is primary
and sustaining life needs to be subordinated to this basic aim. It is no longer credible to regard
the sustaining of life, regarding of its quality, as the primary and paramount concern of
medical practice.

3. Social limits of autonomy

One of the strongest objection to euthanasia is that the autonomy which is our duty to respect is
not enjoyed everyone. It applies to socially empowered individuals or groups within society. There
may be serious problems with the application of this principle to the marginalized group and
especially to individuals who are or can be exploited.                                                                                               
Legalizing euthanasia ignores the social reality of marginalized groups, and persons who might be
exploited by unscrupulous doctors. This is a grave social consequence of legalizing the practice.
 4. It is unnecessary: palliative care provides all the comfort needed

A subsidiary and supporting argument frequently used by opponents of euthanasia is thr claim
that the practice is unnecessary because the relief sought by patient can be adequately
provided with palliative care.

5. Ignorance and uncertainty objections

Another objection to allowing euthanasia is that this irrevocable step should be avoided
because miraculous cure or spontaneous remission might reserve medical misfortune. Clearly
this cannot happen for people who have chosen to end their lives prematurely.
6. Sanctity of life
The final objection to euthanasia is based on the claim that all human life is sacred. This argument
says that euthanasia is bad because of the sanctity of human life.

There are four main reasons why people think we shouldn't kill human beings:

1. All human beings are to be valued, irrespective of age, sex, race, religion, social status or their
potential for achievement
2. Human life is a basic good as opposed to an instrumental good, a good in itself rather than as a
means to an end
3. Human life is sacred because it's a gift from God
4. Therefore the deliberate taking of human life should be prohibited except in self-defense or the
legitimate defense of others.

7. Double effect
The doctrine of double effect is based upon the principle which draws a sharp moral line
between what is intended and what is merely foreseen but not intended.           
When a patient’s condition becomes sufficiently wretched, it is permissible for a doctor to end
the misery with a lethal dose of pain killer, but this must be administrated with the primary
intention of alleviating pain-even though there is also the foreseen but unintended
consequence of killing the patient.
So, some opponents of euthanasia allow that it is permissible to provide treatment ill patients
which hastens death though the intention is not to kill the patient.
THE ISSUE OF POWER   
A pivotal and underlying issue in the debate is the empowering of patients. If legislation
embodies a shift of power from medical professional to the patient, the medical professional
do not welcome such shift of power. Physicians are prepared to help their patients put an end
to their misery-but the timing of lethal overdose remains squarely in medical hands.
Unwillingness to give up power exercised over patient is a widespread feature of medical
practice. Moreover, physician tends to disregard the advance directives of patients. A study at
a major Canadian hospital regarding the use of advance directives in clinical care found that
 40% of physicians questioned, chose a level of care different from that requested in advance
by patient who subsequently became incompetent. The physicians indicated that they would
follow a patient’s advance directive if it was consistent with their own clinical judgment. Also,
they wanted to     ………judgments about treatment regardless of a patients request.
Sometimes it is not so much the issue of power. In some case the doctor in victim of social and
cultural circumstances in which the medical treatment of the patient takes place. This happens
to be a case for example in the relief reported by specialist upon learning of objections of
family members to futile surgery which he had proposed, because he felt that in the absence
of such an objection, he was ethically bound to proceed with the unneeded surgery.                       

Rachel’s distinction b/w killing and allowing die

In certain situations, passive euthanasia ("letting die") is morally permissible. However, active
euthanasia (physician-assisted death) is never morally permissible. Doctors can withhold
treatment in many circumstances, and does nothing wrong if the patient dies, but the doctor
must never, ever "kill" the patient.

According to Rachel’s Thesis : active euthanasia is not any worse than passive euthanasia. He
defines active euthanasia as taking a direct action designed to kill a patient and passive
euthanasia as deliberate withholding of treatment that could prolong patient's life, allowing the
patient to die.

Important assumption: THE JUSTIFICATION for "letting die" is to reduce harm & suffering of the
patient.

In situations for which passive euthanasia is permissible under this justification, there are no
morally sound reason for prohibiting active euthanasia, and in some cases, active euthanasia is
morally preferable to passive euthanasia. (Rachel says that he can understand someone who
opposes both active and passive euthanasia as immoral practices, but cannot make sense of
approving of one and not the other.)

The basis of the conventional doctrine is the distinction between "killing" and "letting die,"
together with the assumption that the difference between killing and letting die must, by itself
and apart from further consequences, constitute a genuine moral difference.

Although most actual cases of killing are morally worse than most actual cases of letting die, we
are more familiar with cases of killing (especially the terrible ones that are reported in the
media), but we are less familiar with the details of letting die. This gap leads us to believe that
killing is always worse. 
First argument against the conventional doctrine is that many cases of "letting die" are WORSE
(for the patient) than is killing them. If the patient is going to die either way, why is it morally
permissible to dehydrate them to death? Either way, the patient is dead. But the conventional
doctrine often adds a requirement of suffering before dying.  He explains this with the help of a
situation:

To begin with a familiar type of situation, a patient who is dying of incurable cancer of the
throat is in terrible pain, which can no longer be satisfactorily alleviated. He is certain to die
within a few days, even if present treatment is continued, but he does not want to go on living
for those days since the pain is unbearable. So he asks the doctor for an end to it, and his family
joins in the request. Suppose the doctor agrees to withhold treatment, as the conventional
doctrine says he may. The justification for his doing so is that the patient is in terrible agony, and
since he is going to die anyway, it would he wrong to prolong his suffering needlessly.

    But now notice this. If one imply withholds treatment, it may take the patient longer to die,
and so he may suffer more than he would if noire direct action were taken and a lethal injection
given. This fact provides strong reason for thinking that, once the initial decision not to prolong
his agony has been made active euthanasia is actually preferable to passive euthanasia, rather
than the reverse. To say otherwise is to endorse the option that leads to more suffering rather
than less, and is contrary to the humanitarian impulse that prompts the decision not to prolong
his life in the first place.

Part of his point is that the process of being "allowed to die" can be relatively slow and painful,
whereas being given a lethal injection is relatively quick and painless.
Second argument is the Bathtub Example of Smith and Jones. It demonstrates that some
cases of letting die are at least as bad as killing.

So, let us consider this pair of cases:

In the first, Smith stands to gain a large inheritance if anything should happen to his six-year-old
cousin. One evening while the child is      taking his bath, Smith sneaks into the bathroom and
drowns the child, and then arranges things so that it will look like an accident.

In the second, Jones also stands to gain if anything should happen to his six-year-old cousin. Like
Smith. Jones sneaks in planning to drown the child in Ills bath. However, just as fie enters the
bathroom Jones sees the child slip and hit his head, and fall face down in the water. Jones is
delighted; he stands by, ready to push the child's head back under if it is necessary, but it is not
necessary. With only a little thrashing about, the child drowns all by himself, "accidentally," as
Jones watches and does nothing. Now Smith killed the child, whereas Jones "merely" let the
child die. That is the only difference between them.
Therefore, we can say that the "bare" difference between killing and letting die doesn’t always
make a moral difference. Therefore, it can be concluded that in many cases where it is right to
let a patient die, it is also right to practice active euthanasia.

But Rachel does not defend active euthanasia (killing), because he never defends the morality
of passive euthanasia. His goal is to challenge the distinction. In a case where "letting die" is
immoral, killing may also be immoral. If "letting die" is always immoral, then one might have a
sound moral reason to object to active euthanasia, too.

Role of advance will in euthanasia:

Advance or Living will is a written document that allows a patient to give explicit
instructions in advance about the medical treatment to be administered when he or
she is terminally-ill or no longer able to express informed consent. It is a concept
associated with passive euthanasia. It is a legal document which allows you to
express your wishes to doctors in case you become incapacitated. In a living will, you
can outline whether or not you want your life to be artificially prolonged in the event
of a devastating illness or injury.

WHO CAN DRAW UP A LIVING WILL/ ADVANCE MEDICAL

DIRECTIVE?
* An adult who is of a sound and healthy mind and in a position to communicate,
relate and comprehend the purpose and consequences of executing the
document.
*It must be voluntary
* It should be in writing and should clearly state as to when medical treatment
may be withdrawn or if specific medical treatment that will have the effect of
delaying the process of death should be given

WHAT SHOULD THE LIVING WILL HAVE? / ESSENTIAL

ELEMENTS OF A LIVING WILL
* It should clearly indicate the decision relating to the circumstances in which
medical treatment can be withdrawn.
* Instructions must be absolutely clear and unambiguous.
* It should mention whether the patient may revoke the instructions/authority
at any time
* It should say that the patient has understood the consequences of executing
such a document.
* It should specify the name of a guardian or close relative who, in the event
of the patient becoming incapable of taking decision at the relevant time, will
be authorized to give consent to refuse or withdraw medical treatment.
* If there is more than one valid Advance Directive, the most recently signed
Advance Directive will be considered as the last expression of the patient‘s
wishes and will be implemented.
ADVANCE WILL CAN HELP OR PLAY A VITAL ROLE FOR THE PEOPLE WHO
MIGHT BE SUFFERING FROM DEMENTIA OR COMA OR ANY OTHER LIFE
THREATENING DISEASE IN WHICH THE PATIENT WILL NOT BE CAPABLE OF
TAKING DECISION IN FUTURE OR AT THE ADVANCE STAGE OF THEIR ILLNESS.