SHOULD PATIENTS BE GIVEN AN OPTION TO END THEIR OWN LIVES

OR TO REQUEST THAT PHYSICIANS TAKE ACTIONS THAT WILL LEAD TO

THEIR DEATH? AND IF SO, WHEN AND UNDER WHAT CONDITIONS?

NAME: MEHAR MAHAJAN

STUDENT ID: 40189036
PHIL 235 EC
 Table of Contents

Introduction .............................................................................................................................. 2

Examining Autonomy and Beneficence: The Ethical Core of Euthanasia ......................... 3

End of Life Choice: Exploring the Ethical and Societal Implications of Euthanasia ........ 6

Conclusion .............................................................................................................................. 10

Bibliography ........................................................................................................................... 11

1
 Introduction

An enchilada of conundrum runs into the discussion of end-of-life decision-making. When

weighing upon this practice, it is paramount to consider the modus operandi associated with it

i.e., multitudinous methodologies to bring about this in actuality. Euthanasia “bringing about

the death of a person in that person’s interest” is one such practice that is further classified as

Active and Passive Euthanasia 1. Passive euthanasia brings about the death of a person when

life-sustaining treatment is withheld or withdrawn, often known as WLST contrarily, active

euthanasia is the administration of a lethal foreign substance to kill the person, which works in

tandem with physician-assisted death (PAD)2. To engage the dialogue further it is vital to

mention that PAD/MAID i.e., active euthanasia had been legalized in Canada in the year, 2015,

for patients meeting a certain eligibility criterion. Since then, a vehement argumentation has

been centered on the ethical and legal implications of allowing and disallowing PAD.

A faction of bioethicists and philosophers are ardent supporters of the legalization of PAD

because perusing it one can identify PAD being deeply ingrained within the essence of

autonomy and beneficence. Simultaneously, philosophers had fervent opinions in opposition

to PAD because it seems to be comprised of multiple flaws namely, not having a “set of

specified policy proposals to legalize euthanasia”3. This deprives policy assessments to have

1 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 288). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

2 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 288). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

3 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 301). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

2
any focus at all and making the legalization of PAD inevitable to a level of possible

exploitation4 which can take away the pious gift of life.

PAD/Euthanasia is a practice that is growing at an alarming rate and is affecting not only an

individual or his/her family but society because it involves a conflict between two important

values: respect for individual independence and respect for life. Bringing such a practice into

existence can be proven harmful or utilitarian. Thus, these contradictions deem it eloquent to

discuss the plethora of facets encompassing PAD as it can distinctly identify a kaleidoscope of

perspectives towards many controversial issues.

This essay will attempt to analyze the paradoxical notions mentioned above and determine

whether PAD must be a fundamental human right that can be exercised whenever a competent

person desires it or should be prohibited as a "supposed" precautionary measure for public

health and the physician's virtues.

Examining Autonomy and Beneficence: The Ethical Core of Euthanasia

“Human beings are not mere objects but are fundamentally self-determining beings and the

worst thing that can happen to them is loss of their dignity”5, emerging from the fundamentals

of Kant’s deontological ethics, this is a pioneer argument in support of euthanasia. Most

lucidly, it advocates a human being’s right over his/her body, foreshadowing the

implementation of autonomy. The sole purpose of autonomy is not merely about justifying a

4 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 315). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

5 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 12). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

3
patient’s right to deny a particular line of treatment, but it also marks his/her prerogative to

decide what is good for their livelihood, and future and take a decision that can alleviate

suffering. Therefore, autonomy/self-determination inevitably safeguards a person’s dignity.

The copious mention of dignity drives attention to what is “dignity” and why is it pertinent to

be a strong aspect of rationalization in support of euthanasia. This is because as per Brock’s,

piece of work, “self-determination or autonomy and individual well-being” centralize the

fundamental ethical justifications for PAD and constitute a “central aspect of human dignity”6.

The aforementioned principles highlight the aspect of why it is appropriate to legalize patients’

ability to choose whether to end their lives. A series of distinctly defined guidelines established

by the Supreme Court of Canada in the Carter Case undoubtedly govern this judgment, and

one of the regulations states that “illness, disease or state of decline causing enduring physical

and psychological suffering that is intolerable and cannot be relieved is acceptable to undergo

PAD”7. This regulation prima facie is an emblem of the ethics embedded into it namely,

compassion, beneficence, and non-maleficence.

When a person is diagnosed with a terminal illness that is irreversible and causing them

excruciating pain, is it morally right to let them suffer? Often, killing or allowing someone to

die is deemed wrong because it is analogous to robbing a being of a precious life and a

promising future. As per the consequentialist theory, beneficence promotes maximum

goodness and contentment. Hence, it is not a moral compromise to take away a patient’s life

when they feel that their life is full of “impairments and burdens and it is sufficient to make

6 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 298). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

7 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 293). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

4
life no longer worth living”8. This is only promising dignity, compassion, and exercising self-

determination. Additionally, it does not contradict a physician’s virtues of the Hippocratic Oath

because in such a case a physician is relieving the patient off their sufferings which fulfills

their innate role of being “obligated to the patient’s best interest”9.

The seriatim bewilderment regarding PAD doesn’t conclude here. This is in response to

bioethicists' assertion that there is a line dividing killing from allowing death, with killing being

a considerably more heinous act. This is because nothing is “done” to kill the patient when

merely allowing them to die rather, an HCP just returns him/her to their normal, untreated life,

hence letting them pass away is not the doctor's obligation 10. However, Dan W. Brock

painstakingly explains why this difference is problematic by using the hypothetical case of an

ALS patient who is "allowed to die" in one scenario by her doctor and in another by her

avaricious son11. Brock points out that even though both the physician and the son merely

allowed the patient to die but the action performed by both “intended to cause death, do cause

death, and so both killed”12. So, then the question raised becomes is it always wrong to kill?

8 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 298). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

9 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 23). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

10 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 299). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

11 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 299). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

12
Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 300). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

5
Or is killing justified if performed by an HCP? Putting things into perspective, it is integral to

forecast the intentions channelized by the parties involved. By bringing about the patient's

death following his or her wishes, the doctor not only honored the patient's self-determination

and consent but also carried out his/her obligation to relieve pain. Subsequently, the son’s call

was precluded from any self-determination/autonomic rights of the patients, hence, was not

only an infringement of the patient’s dignity but also morally unjustified. This contributes to

the second question's justification that an HCP's killing action isn't necessarily immoral and, in

essence, is "part of their job" 13. Therefore, euthanasia/PAD is not unethical when viewed from

the doctor's and patient's perspectives.

End of Life Choice: Exploring the Ethical and Societal Implications of Euthanasia

Despite what preceded it is key to accentuate that PAD/Euthanasia has a torrent of ethical and

legal implications that makes the opposition question its legality. One of the prime reasons why

euthanasia is malpractice lies in the argument of self-determination that supports euthanasia in

the first place. As per self-determination “people are presumed to have an interest in deciding

for themselves”14 but talking about euthanasia, is it a decision involving the participation of

the patient alone? PAD/Euthanasia cannot be practiced unless facilitated by a physician. What

if the moral virtues and commitment of a physician do not allow him to “kill”? In such an

13 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 292). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

14 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 313). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

6
event, should he be forced to “kill’? Isn’t that a violation of the physician’s right to self-

determination?

When a patient wants to undergo PAD, he/she is “waiving off their respective right to not be

killed”15 but it is noteworthy that waiver of such a right is not making them responsible for

their end-of-life rather it is a “transfer of rights from one to another” 16. The answer to that shall

be no because coercion of any kind onto the physician only banishes away the right to self-

determination. Besides this, it is essential to consider that “any competent individual” 17 must

not be able to kill or decide the fate of another individual regardless of their motives. Daniel

Callahan sums up that forceful consensual adult killing is synonymous with consenting adult

slavery and, giving one’s fate of life in another’s hand for killing is analogous to dueling, both

of which cause a potential menace to human dignity 18.

Compassion and beneficence cited as key justifications for euthanasia are often fraught with

uncertainty. When people believe their lives are difficult and are worried about what their later

years would entail, PAD is usually sought because these attributes seem enough “to not

15 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 301). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

16 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 313). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

17 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 313). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

18 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 313). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

7
consider their life worth living anymore” 19. Pragmatically, it is essential to take note that the

sense of perception towards life as not being worthy anymore is not just an easy way out of

problems but also promotes the idea to succumb to fear.

Besides the idea of the quality of life, the system often fails to define the intensity of suffering,

and the debilitating nature that is the benchmark for a patient to undergo PAD. The idea of pain

and suffering is very objective, what might be painful and worthy of undergoing PAD for one

may not be sufficient for another person with the same condition. In such a case, it is often the

doctor who will have to take the call on whether a particular life is worth living or not despite

them agreeing that there is no set of rules to measure the intensity of pain or suffering 20.

This argument against euthanasia sews another bead to the thread, asking if “suffering” and

“pain” is undefinable then how is the implementation of PAD on these grounds legitimate?

This brings light to the policy-centered shortcomings of euthanasia. The lack of definitive

safeguards towards euthanasia poses a grave risk to public health because if the decision-

making is relentlessly conferred to HCPs, they are being held synonymous to gods and deities

and “doing what usually nature decides” 21. The ability to decide "which life is more

19 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 298). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

20 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 313). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

21 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 314). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

8
important"22 based on specific "morals and interpretations"23 might further embolden doctors

with a sense of self-glorification. Furthermore, Callahan states that a physician can consider a

life not worthy anymore in the event of them believing that medical treatment will no longer

be effective in sustaining life and this direct killing can also be a calculative economic

interest24. This leads to the slippery slope of euthanasia- exploitation, misuse, and coercion to

undergo PAD.

Since one of the regulations stated by law for PAD states intrinsically that a competent

individual must be allowed to make an end-of-life decision for themselves on the grounds of

human dignity then it is an unabashed charge of cruelty that someone who is psychologically

incompetent should be denied the right to alleviate his suffering.

Semantic relevance derived from the gatherings of these proposed arguments efficiently talks

about the dichotomy of implementation of PAD which causes an insurmountable divide

amongst the society in terms of faith, potential abuse due to financial divide, and loss of

humanity.

22 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 314). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

23 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 314). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

24 Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A
Canadian Focus (Third Edition, pp. 314). story, Oxford University Press. Retrieved
March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

9
 Conclusion

Decisively, PAD is a practice that unconditionally guarantees a person the right to self-

determination and relieves them of irreparable suffering however, the underlying idea is that

PAD never directly targets a person's right to self-determination. It is a partnership between

the patient and the doctor i.e., a decision must consider the autonomy of both parties.

Additionally, legalizing PAD does help many people who are in situational crisis, but as is

lucid from the arguments, lax regulation of the practice will have a detrimental effect on public

policy and health, and unavoidably, it can eventually erode patient-doctor trust. If a doctor's

assessment of the case's relevance is going to be the deciding factor, it would not only cause a

wave of fear among patients but also destroy the essence of "being a doctor." Additionally,

PAD can also be a facile solution for those unable to afford medical treatment leading to a

societal divide and plausible coercive exploitation by family inmates. The legal system and the

ethical world of medical sciences must work together to bridge the gap between the

ambiguously defined policies that not only safeguard the implementation of euthanasia but also

ensure that all the patients be adequately imparted with the best dialogue so they can come to

a decision that is devoid of any coercion or preconceived notion.

Henceforth, a critical engagement in a healthy dialogue and a consistent markdown of each

perspective offered will better regulate the implementation of euthanasia and augment society

further.

10
 Bibliography

1. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 288). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

2. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 288). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

3. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 301). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

4. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 315). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

5. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 12). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

6. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 298). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

7. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 293). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

8. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 298). story, Oxford University Press. Retrieved

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11
9. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 23). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

10. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 299). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

11. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 299). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

12. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 300). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

13. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 292). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

14. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 313). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

15. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 301). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

16. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 313). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

12
17. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 313). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

18. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 313). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

19. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 298). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

20. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 313). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

21. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 314). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

22. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 314). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

23. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 314). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

24. Fisher, J., Russell, J. S., Browne, A., & Burkholder, L. (2018). In Biomedical Ethics: A

Canadian Focus (Third Edition, pp. 314). story, Oxford University Press. Retrieved

March 28, 2023, from https://reader.texidium.com/dist/#/book/17211.

13