Research Paper for Philosophy of Law

EH408 JDNT-1

EUTHANASIA: BALANCING AUTONOMY AND THE SANCTITY OF LIFE

THE RIGHT TO LIVE VS. THE RIGHT TO DIE

By:

Ogario, Jean Paul Taihei

INTRODUCTION

Imagine a society in which patients are routinely euthanized—whether they want their
lives to end or not, if their suffering cannot be alleviated without dulling their
consciousness, eliminating their independence, or threatening their dignity. In such a
society, defenders of the status quo might argue that the duty to prevent suffering and
indignity makes the policy imperative. A compelling response would be that, while
suffering, indignity, and loss of independence are undesirable, only the person enduring
them should decide whether they are unbearable. If a patient is competent to decide,
nobody other than that patient should have the authority to decide whether life is worth
continuing.

The very same argument, however, can be advanced against the current practice, prevalent
in most countries, of prohibiting people from seeking assistance to end their lives. Although
some people might decide that the suffering and indignity that characterize their lives are
not sufficiently bad to make life not worth continuing, other people in the same situation
will deem their condition unbearable. Just as it would be wrong to force people to die, so is
it wrong to force people to endure conditions that they find to be unbearable.

The decision about whether to continue living in such conditions is among the most
important that can be made. Just as people value having control over where to live, which
occupation to pursue, whom to marry, and whether to have children, so people value
having control over whether to continue living when quality of life deteriorates. That is
why the right to life and the right to die are not two rights, but two aspects or descriptions
of the same right. The right to life is the right to decide whether one will or will not
continue living. The right to die is the right to decide whether one will die (when one could
continue living). If the right to life were only a right to decide to continue living and did not
also include a right to decide not to continue living, then it would be a duty to live rather
than a right to life. The idea that there is a duty to continue living, regardless of how bad life
has become, is an implausible one indeed.

Euthanasia has always been in glow of publicity and as a subject of debate in the field of
medicine and law. It is one of the most confusing issues which the world is facing today
when it comes to the life of a patient with fatal illness and intense pain, who is in a vegetate
state and cannot support life with dignity. Badly handicapped or terminally ill patients are
supposed to have the right to choose between life and death. Euthanasia throughout the
world has been much debated subject and India entered into this debate since the case of
Aruna Ramchandra Shanbaug who was sexually assaulted by a ward boy. The present
study provides the case of countries which have execute legislations to euthanasia. Among
these countries Netherlands was the first to legalize euthanasia and later was joined by
Canada, Columbia, Belgium, and the state of Oregon in USA. India also joined these
countries which have legalized mercy killing in some form, so far ‘Passive Euthanasia’ is
legalized by Supreme Court in India. Various forms of euthanasia have been highlighted in
the present research article, the most prominent among them include Active and Passive
euthanasia, Voluntary and Non-Voluntary euthanasia. In this study an attempt is made to
examine the arguments in favor and against euthanasia, an account of euthanasia and the
position of life in Islam is also explored. The research method used for the growth and
analyzation of data in the current study is descriptive method.
OVERVIEW

The right to live and the right to die represent two fundamental yet contrasting aspects of
human existence and autonomy.

Right to Live:
The right to live is a fundamental principle that asserts every individual's entitlement to
life, safety, and security. It's often considered a foundational human right. It encompasses
protection against harm, violence, and undue threats to one's life. Various international
human rights declarations and national laws emphasize the right to life as a fundamental
principle.

Right to Die:
On the other hand, the right to die refers to an individual's autonomy and freedom to make
decisions about their own life, particularly in the context of choosing to end their life, often
in cases of terminal illness, unbearable suffering, or at an advanced age. This concept
is often
associated with the right to die with dignity, allowing individuals the choice of euthanasia,
assisted suicide, or refusal of life-prolonging medical treatments.

These two rights can come into conflict in complex ethical, legal, and moral situations,
especially in cases where an individual's desire to end their life clashes with societal or
legal norms that prioritize the preservation of life.

Debates and Considerations:

The ethical considerations surrounding the right to die are intricate. Advocates argue for
the right to die based on personal autonomy, quality of life, and the relief of unbearable
suffering. Opponents often raise concerns about potential abuse, the sanctity of life, and the
ethical implications for society and healthcare.

Legal frameworks around the world vary significantly concerning the right to die. Some
countries or states have legalized certain forms of assisted dying under specific
circumstances, while others maintain strict prohibitions against any form of assisted death.

Balancing Both Rights:

Balancing these rights involves a nuanced approach that considers various factors,
including individual autonomy, quality of life, medical ethics, cultural and societal norms,
religious beliefs, and the legal framework. Ethical and legal discussions aim to find a middle
ground that respects both the right to life and the right to self-determination.

Ultimately, these rights raise profound questions about personal autonomy, individual
freedom, human dignity, and the responsibilities of society and the state in preserving life
and respecting an individual's choices. Finding a balance between these two fundamental
rights remains an ongoing and complex challenge in various societies worldwide.

ANALYSIS
Let us look at the definitions of ethics, morals, and law. Ethics is the moral principles that
govern a person's behavior or the conducting of an activity. Morals are concerned with the
principles of right and wrong behavior and the goodness or badness of human character.
Law is the system of rules that a particular country or community recognizes as regulating
the actions of its members and may enforce by the imposition of penalties.

If you are ethical you can abide by the law. If you are Moral you can be ethical. Also, if you
are moral you can abide by the law. But you can never be all three together.

Morality governs private, personal interactions. Ethics governs professional interactions.

Law governs society as a whole, often dealing with interactions between total strangers.

Ethics and morals relate to “right” and “wrong” conduct. While they are sometimes used
interchangeably, they are different: ethics refer to rules provided by an external
source, e.g.,
codes of conduct in workplaces or principles in religions. Morals refer to an individual's
own principles regarding right and wrong.

Morals and Law differ because the law demands an absolute subjection to its rules and
commands. Law has enforcing authority derived from the state. It is heteronymous (being
imposed upon men upon the outer life of men). Law regulates men’s relations with others
and with society.

International Perspectives:

Legalization: Some countries have legalized euthanasia or assisted dying under specific
circumstances and with stringent regulations. For instance, countries like the Netherlands,
Belgium, Luxembourg, Canada, Colombia, and some states in the United States have
enacted laws allowing euthanasia or physician-assisted suicide under specific conditions,
often involving terminal illness, unbearable suffering, and a strict process of consent and
evaluation.

Prohibition: Many countries strictly prohibit euthanasia and assisted suicide. These
nations uphold laws that consider such actions as illegal and subject to criminal
prosecution. This includes countries like the Philippines, Germany, Italy, and many
others.

Debates and Considerations: The issue of euthanasia prompts ethical, moral, and legal
debates globally. Discussions often revolve around autonomy, quality of life, the sanctity of
life, potential for abuse, palliative care, and the role of healthcare professionals.

International Human Rights Perspective: The right to die is often considered within the
broader context of human rights. Some argue that the right to die with dignity and freedom
from suffering should be recognized as part of an individual's right to autonomy
and self-determination. However, others argue that the right to life itself supersedes the
right to choose death.

International Organizations and Guidelines:

 Organizations like the United Nations (UN) and the World Health Organization (WHO) have
discussed end-of-life care, palliative care, and the ethical considerations surrounding
euthanasia in various reports and discussions.

The UN and WHO emphasize the importance of palliative care, pain management, and
improving end-of-life care for individuals facing terminal illnesses. They promote the idea
of providing comprehensive support to enhance the quality of life of terminally ill patients
while respecting their dignity and autonomy.

Euthanasia and assisted suicide are illegal in the Philippines. The Philippine law does not
provide for the legalization of euthanasia or physician-assisted suicide (PAS).

Article II, Section 12 of the 1987 Philippine Constitution explicitly states: "The State
recognizes the sanctity of human life. It shall protect and strengthen the family as a basic
autonomous social institution. It shall equally the unborn from Moreover, discussions
regarding euthanasia or the right to die in the Philippines have been largely contentious
due to various factors, including religious beliefs, cultural values, and the strong influence
of the Roman Catholic Church, which opposes euthanasia and assisted suicide.

However, it's essential to note that laws and perspectives may change over time, and there
could have been developments or proposed legislation after my last update. It's advisable
to consult the most recent legal resources or news sources for any potential changes or
evolving discussions related to the right to die in the Philippines.

Euthanasia remains a highly sensitive and contested issue globally, with divergent
perspectives among countries, cultures, legal systems, and ethical beliefs. International
discussions continue, focusing on providing compassionate care for terminally ill
individuals while balancing considerations of individual autonomy, societal values, and the
sanctity of life. Laws and perspectives on euthanasia are subject to change and ongoing
debate as societies grapple with the complexities of end-of-life decisions.

DISCUSSION OF ARGUMENTS

Arguments against euthanasia Eliminating the invalid: Euthanasia opposers argue that if we
embrace ‘the right to death with dignity’, people with incurable and debilitating illnesses will
be disposed from our civilized society. The practice of palliative care counters this view, as
palliative care would provide relief from distressing symptoms and pain, and support to the
patient as well as the care giver. Palliative care is an active, compassionate and creative care
for the dying. Constitution of India: ‘Right to life’ is a natural right embodied in Article 21 but
suicide is an unnatural termination or extinction of life and, therefore, incompatible and
inconsistent with the concept of ‘right to life’.

It is the duty of the State to protect life and the physician’s duty to provide care and not to
harm patients. If euthanasia is legalized, then there is a grave apprehension that the State
may refuse to invest in health (working towards Right to life). Legalized euthanasia has led to
a severe decline in the quality of care for terminally-ill patients in Holland . Hence, in a
welfare state there should not be any role of euthanasia in any form.
Symptom of mental illness: Attempts to suicide or completed suicide are commonly seen in
patients suffering from depression, schizophrenia and substance users. It is also documented
in patients suffering from obsessive compulsive disorder. Hence, it is essential to assess the
mental status of the individual seeking for euthanasia. In classical teaching, attempt to suicide
is a psychiatric emergency and it is considered as a desperate call for help or assistance.
Several guidelines have been formulated for management of suicidal patients in psychiatry.
Hence, attempted suicide is considered as a sign of mental illness.

Malafide intention: In the era of declining morality and justice, there is a possibility of
misusing euthanasia by family members or relatives for inheriting the property of the
patient. The Supreme Court has also raised this issue in the recent judgement . ‘Mercy
killing’ should not lead to ‘killing mercy’ in the hands of the noble medical professionals.
Hence, to keep control over the medical professionals, the Indian Medical Council
(Professional Conduct, Etiquette and Ethics) Regulations, 2002 discusses euthanasia in
Chapter 6, Section 6.7 conception." and it is in accordance with the provisions of the
Transplantation of Human Organ Act, 199414. There is an urgent need to protect patients
and also medical practitioners caring the terminally ill patients from unnecessary lawsuit.
Law commission had submitted a report (no-196) to the government on this issue.

Emphasis on care: Earlier majority of them died before they reached the hospital but now it
is converse. Now sciences had advanced to the extent, life can be prolonged but not to that
extent of bringing back the dead one. This phenomenon has raised a complex situation.
Earlier diseases outcome was discussed in terms of ‘CURE’ but in the contemporary world of
diseases such as cancer, Aids, diabetes, hypertension and mental illness are debated in terms
best ‘CARE’, since cure is distant. The principle is to add life to years rather than years to life
with a good quality palliative care. The intention is to provide care when cure is not possible
by low cost methods. The expectation of society is, ‘cure’ from the health professionals, but
the role of medical professionals is to provide ‘care’. Hence, euthanasia for no cure illness
does not have a logical argument. Whenever, there is no cure, the society and medical
professionals become frustrated and the fellow citizen take extreme measures such as
suicide, euthanasia or substance use. In such situations, palliative and rehabilitative care
comes to the rescue of the patient and the family. At times, doctors do suggest to the family
members to have the patient discharged from the hospital wait for death to come, if the
family or patient so desires. Various reasons are quoted for such decisions, such as poverty,
non-availability of bed, futile intervention, resources can be utilized for other patients where
cure is possible and unfortunately majority of our patient’s family do accordingly. Many of the
terminally ill patients prefer to die at home, with or without any proper terminal health care.
The societal perception needs to be altered and also the medical professionals need to focus
on care rather in addition to just cure. The motive for many euthanasia requests is
unawareness of alternatives. Patients hear from their doctors that ‘nothing can be done
anymore’. However, when patients hear that a lot can be done through palliative care, that
the symptoms can be controlled, now and in the future, many do not want euthanasia
anymore

What about personal choice?

The pro-euthanasia and assisted suicide lobby emphasize the importance of personal choice
and autonomy. Shouldn’t patients have the right to end their lives? Dignity in Dying patron,
Sir Patrick Stewart has argued “We have no control over how we arrive in the world but at
the end of life we should have control over how we leave it.”
Surely however the debate is not about the right to die; it is about the right to help patients
kill themselves. Instead of giving freedom to patients, euthanasia and assisted suicide is about
giving other people the legal power to end another person’s life.

Assisted suicide is not a private act. Nobody chooses assisted suicide in isolation. Euthanasia
and assisted suicide are matters of public concern because they involve one person
facilitating the death of another. Friends, relatives, healthcare staff and society are hugely
affected by the wider ramifications of the process.

Journalist and author George Pitcher has said that any change in the law would have
“profound adverse affects on the social fabric of our society, on our attitudes towards each
other’s deaths and illnesses, on our attitudes towards those who are ill and have
disabilities.”brieflyprotect the life of the mother and Increased autonomy would apply
disease where the prognosis is not straightforward, dementia or a chronic but not terminal
disease, then you would not meet the criteria; attempts to extend the law further would be
almost inevitable. Assisted suicide is not a private act and there is a real risk that a ‘right to
die’ may soon become a ‘duty to die’.

What about compassion?

The pro-euthanasia and assisted suicide lobby will often present the view that helping
someone else to end their life is the most loving and compassionate thing to do. But surely the
most compassionate thing to do is to care for a person at the end of their life and to show
them that their life has tremendous value regardless of age or abilities.

Palliative care is an area of healthcare that focuses on relieving and preventing the suffering
of patients. Britain is the only country in the world where palliative care is a recognised
medical specialism. Further, in a recent survey by The Economist Britain was ranked first in
the world for quality end-of-life care. The survey took in 40 OECD and non-OECD countries,
including the USA, the Netherlands, Germany and France.

What about the most vulnerable?

Changing the law to allow euthanasia or assisted suicide will inevitably put pressure on
vulnerable people to end their lives for fear of being a financial, emotional or care burden
upon others. This would especially affect people who are disabled, elderly, sick or depressed.
Some would face the added risk of coercion by others who might stand to gain from their
deaths. Fear and anxiety would be promoted rather than Individual autonomy.

In its 1994 report The House of Lords Select Committee on Medical Ethics concluded:

“It was virtually impossible to ensure that all acts of euthanasia were truly voluntary and that
any liberalisation of the law in the United Kingdom could not be abused. We were also
concerned that vulnerable people – the elderly, lonely, sick or distressed – would feel
pressure, whether real or imagined, to request early death.”

The law must protect the most vulnerable people in society. We must never let the depressed,
the confused, those in terrible pain, the aged and the vulnerable feel that they should pursue
the path of assisted suicide so as not to be a burden on others.
Dr Andrew Fergusson, of the Care Not Killing Alliance, has said “the simple truth is that the
current law exists to protect those without a voice: the disabled, terminally ill and elderly, who
might otherwise feel pressured into ending their lives”.

What next?
Studies concerning the euthanasia and assisted suicide law in countries that have legalised
such measures make for troubling reading.

A study conducted in 2012 shows that 32% of the assisted deaths in Belgium are carried out
without request and 47% of assisted deaths go unreported in the Flanders region of Belgium.
Another recent study found that nurses are regularly euthanasing their patients in Belgium
even though the laws prohibits it. Since was legalised in one attempt to prosecute for abuses
of the euthanasia law. In addition to this the study shows there was a 25% increase in the
number of assisted deaths in Belgium in 2012.

In Oregon (where assisted suicide was legalised in 1997) the law has led to patients ‘doctor
shopping’ for willing practitioners, using doctors who have minimal knowledge of their past.
In 2008, 50 per cent of patients requesting suicide were assisted to die by a doctor who had
been their physician for eight weeks or less.

Not all people who are terminally ill wish to end their life.
There have been tragic cases of people suffering terminable illness who want other people to
help them end their life. It is important however that we do not lose sight of the large number
of people who are terminally ill and have found richness and purpose in life despite the pain
and hardship.

A survey published by the British Medical Journal in 2011 found that the majority of patients
who are almost completely paralysed but fully conscious have said they are happy and do not
want to die. The survey questioned 168 members of the French Association for Locked-in
Syndrome.

Matthew Hampson was a promising young rugby player until a collapsing scrum left him
paralysed from the neck down and requiring a ventilator to breathe. Matt divides his time
between raising money for spinal care for UK charity Spinal Research, coaching youngsters at
local schools and writing columns for rugby magazines. He has also written an
autobiography. The Matt Hampson Foundation provides help, advice and for young people
seriously injured through sport.

All life has profound human value.

We have to make clear that the value of life should not be determined by its benefit to others,
or what it can contribute to society. The French biologist and philosopher Jean Rostand once
said: “For my part I believe that there is no life so degraded, debased, deteriorated, or
impoverished that it does not deserve respect and is not worth defending with zeal and
conviction.”

The discussion surrounding euthanasia involves a multitude of arguments from various

perspectives.

Pro-Euthanasia Arguments:
Autonomy and Personal Choice: Advocates argue that individuals have the right to
decide the timing and manner of their death, especially when faced with unbearable
suffering or terminal illness. They emphasize the importance of respecting an
individual's autonomy and self-determination in making end-of-life decisions.

Relief from Unbearable Suffering: Supporters of euthanasia argue that it is a

compassionate act that alleviates extreme physical and psychological suffering. Allowing
terminally ill patients to choose a peaceful and dignified death can relieve prolonged pain
and maintain their dignity.

Quality of Life: Proponents stress the importance of considering the quality, rather than
just the duration, of life. They argue that if an individual's life is filled with unbearable
suffering and there's no prospect of improvement, they should peaceful and dignified
death.

Anti-Euthanasia Arguments:

Sanctity of Life: Opponents often highlight the sanctity of human life as an essential moral
principle. They argue that deliberately ending a life, regardless of the circumstances,
violates the intrinsic value of life and undermines the respect for its sanctity.

Potential for Abuse and Slippery Slope: Critics express concerns about the potential for
abuse and coercion if euthanasia is legalized. They fear that vulnerable individuals, such as
the elderly or disabled, might feel legalization of euthanasia might gradually expand to
include individuals who are not terminally ill or are otherwise vulnerable.

Medical Ethics and Role of Healthcare Professionals: Many healthcare providers are
concerned about the ethical implications of participating in euthanasia. They argue that
ending a life contradicts the fundamental principle of healing and caring for patients,
raising questions about the ethical boundaries of the medical profession.

Palliative Care Alternative: Opponents often advocate for improved palliative care and
pain management as an alternative to euthanasia. They argue that with proper palliative
care, patients can find relief from suffering without resorting to ending their lives.

These arguments reflect the complexities and ethical dilemmas inherent in the euthanasia
debate. Discussions involve considerations of individual autonomy, quality of life, the
sanctity of life, societal values, medical ethics, and the role of healthcare professionals. The
ongoing dialogue continues to navigate the nuances and ethical implications surrounding
end-of-life decisions.

Counterargument of euthanasia supporters: Caregivers burden: ‘Right-to-die’ supporters

argue that people who have an incurable, degenerative, disabling or debilitating condition
should be allowed to die in dignity. This argument is further defended for those, who have
chronic debilitating illness even though it is not terminal such as severe mental illness.
Majority of such petitions are filed by the sufferers or family members or their caretakers.
The caregiver’s burden is huge and cuts across various domains such as financial, emotional,
time, physical, mental and social. Hence, it is uncommon to hear requests from the family
members of the person with psychiatric illness to give some poison either to patient or else to
them. Coupled with the States inefficiency, apathy and no investment on health is mockery of
the ‘Right to life’.

Refusing care: Right to refuse medical treatment is well recognized in law, including medical
treatment that sustains or prolongs life. For example, a patient suffering from blood cancer
can refuse treatment or deny feeds through nasogastric tube. Recognition of right to refuse
treatment gives a way for passive euthanasia. Many do argue that allowing medical
termination of pregnancy before 16 weeks is also a form of active involuntary euthanasia.
This issue of mercy killing of deformed babies has already been in discussion in Holland.

Right to die: Many patients in a persistent vegetative state or else in chronic illness, do
nothave the option of a want to be a burden on their family members. Euthanasia can be
considered as a way to upheld the ‘Right to life’ by honoring ‘Right to die’ with dignity.

Encouraging the organ transplantation: Euthanasia in terminally ill patients provides an

opportunity to advocate for organ donation. This in turn will help many patients with organ
failure waiting for transplantation. Not only euthanasia gives ‘Right to die’ for the terminally
ill, but also ‘Right to life’ for the organ needy patients.

If the State takes the responsibility of providing reasonable degree of health care, then
majority of the euthanasia supporters will definitely reconsider their argument. We do
endorse the Supreme Court Judgement that our contemporary society and public health
system is not matured enough to handle this sensitive issue, hence it needs to be withheld.
However, this issue needs to be re-examined again after few years depending upon the
evolution of the society with regard to providing health care to the disabled and public health
sector with regard to providing health care to poor people.
The Supreme Court judgement to withhold decision on this sensitive issue is a first step
towards a new era of health care in terminally ill patients. The Judgment laid down is to
preserve harmony within a society, when faced with a complex medical, social and legal
dilemma. There is a need to enact a legislation to protect terminally ill patients and also
medical practitioners caring for them as per the recommendation of Law Commission
Report-19615. There is also an urgent need to invest in our health care system, so that poor
people suffering from ill health can access free health care. Investment in health care is not a
charity; ‘Right to Health’ is bestowed under ‘Right to Life’ of our constitution.
CONCLUSION

The conclusion to the debate between the right to live and the right to die remains complex
and often lacks a definitive resolution due to its ethical, moral, legal, and societal intricacies.
Both rights present profound considerations, and finding a harmonious balance between
them is challenging.

The right to live is often regarded as a fundamental human right, emphasizing the inherent
value and sanctity of life. It encompasses protections against harm, violence, and threats to
one's existence. It's rooted in ethical, moral, and legal frameworks that prioritize
preserving life and promoting well-being.

Conversely, the right to die represents an individual's autonomy and self-determination,

particularly in the context of making end-of-life decisions. This right seeks to provide
 individuals facing terminal illness or unbearable suffering with the choice to end their lives
peacefully and with dignity.

The discussion continues globally, involving healthcare professionals, ethicists,

policymakers, religious leaders, and communities. It aims to find common ground that
respects human dignity, promotes compassionate care, and acknowledges the complexities
of individual autonomy and the value of life.

In conclusion, reconciling the right to live and the right to die necessitates ongoing ethical
and legal discourse, seeking ways to respect individual autonomy against potential harms,
ensuring comprehensive end-of-life care, and upholding societal values that honor both life
and personal choice. This ongoing dialogue remains essential in addressing the multifaceted
dimensions of this challenging and deeply personal issue.

Euthanasia is an alarming issues in the present era where we have both class firstly who
support it and on the contrary those who object its implementation. Those who are in favour
of legalizing euthanasia emphasis circumstances in which a condition has become vigorously
burdened some for the patient, pain management for the patient is inappropriate and only
death looks capable of bringing relief. But at the same time there is another class who are
very much against to the legalization of euthanasia in its any form whether passive or active,
voluntary or non-voluntary. But so far in the present era of science and technology is
concerned and also modern inventions in medical science euthanasia in its active or passive
form can be avoided. The need is to open the gates of moral and ethical values which could
create a friendly environment to the patients who are suffering from acute pain or who are in
a persistent fatal state. If the State takes the responsibility of providing equitable degree of
health care, then majority of the supporters of euthanasia will definitely reconsider their
argument. Euthanasia is to be resorted only when all other options have been disabled and
even in an extreme emergency it should be taken into consideration

Suggestions
Here are some suggestions needed that could bring in focus the proper use of euthanasia:
1. Need of the hour is to analyze the legislations regarding euthanasia, at the same time
such regulations should be passed under which proper steps should be taken to save
such patients who wants to live in spite of their sufferings.
2. The patients who are suffering from fatal illness shall be provided with financial
support so that they could no longer be burden on their family and relatives.
3. Doctors should be given training about the use of latest medical science and
technology which could determine their course of decision while meeting with such
patients.
4. Strong relationship between doctor and patient is essential which could build ethical
and moral values among physicians and they could do every possible effort to save the
life of a patient suffering from intense pain.

Such patients should not be forced to die instead they should be given freedom to choose
between life and death.