There are many bioethical issues to discuss but I’d rather choose the Euthanasia to relate to our moral theory, the famous utilitarianism. The utilitarianism is complete and integrated and is one of the major theory central to nursing, alongside deontology.
A hundred and years ago, to question the absolute worth of human life is a very important matter. Committing suicide is hindered by the society and doing this is unethical. In relation to this thought, asking a doctor to help someone’s life to end i s really absurd. Up until this present time, physicians who were assisting and allowing their patients to be killed or commit suicide remains a very confusing thought, both legally and morally. In this blog I will discuss the moral permissibility of Euthanasia.
Although most of my blockmates discussed about this particular topic, I would still love to express my inner feelings and opinions for this matter. So Euthanasia goes like this. When a patient has a fatal disease and has no view of future recoveries, they weren’t able to receive prolonging treatment rather, they die in an artless way. This artless way of death is what we call as Euthanasia.
However, Euthanasia is roughly classified into two —active and passive. The active one is making one die or what we refer to as killing. The other one, which is the passive, is letting or allowing one to die. Passive euthanasia occurs when the patient dies because the medical professionals either don’t do something necessary to keep the patient alive, or when they stop doing something that is keeping the patient alive. On the other hand, active euthanasia is done with more active means such as the use of potassium chloride, muscle-relaxing medicine and so on.
Animals, child, non-voluntary, involuntary and voluntary —are the types of Euthanasia. But for this blog, I chose what I think I can elaborate in a beautiful manner, and for this reason I probably prefer Voluntary Euthanasia or in other words, death in a painful manner, to be my topic.
To make it simple, let’s make it hypothetical. Suppose I ask you to either kill me or let me die, that my medical condition gets so bad and that I am delirious and won’t recover. If you then comply to my request, we have what we call as Voluntary Euthanasia. We call it as voluntary because the person killed wanted to end his life.
Our main argument for Euthanasia is a Utilitarian one. Utilitarians believe that any action should cause the greatest happiness for the greatest number, and the end result is what should determine the moral worth of the initial action. Since Euthanasia will increase happiness and decrease pain at the same time, then it is morally correct, they argued.
If we are about to calculate the resulting actions, Euthanasia will increase the utiles of a terminally ill patient but decreases the utiles that represents the pain. The level of pain and the progression of the disease would also render the person unable to enjoy the activities that made his life pleasurable, so there could be no higher intellectual or emotional pleasures to balance the physical pain. At best, the person continues to suffer at the negative seven; if his illness has not reached its climax, his suffering may increase. In contrast, his death will create a value of zero, and thus misery is reduced. Moreover, his family and friends will be spared the pain of watching him suffer through a prolonged illness.
Utilitarians also do believe that one has complete sovereign over their body and any decisions to be made about one’s body are up to them and no other authority. If a person volunteers to die in his own will, then it is their right to make his decision and people, even the government, has no right to interfere.
Another thing regarding Euthanasia, traditional utilitarian justifications against killing do not apply. According to Singer, the reason that randomly killing innocent people is morally wrong for a rule utilitarian is that people would suffer considerable anxiety from knowing that their life could be terminated at any point in time.
Lastly, one must not choose Euthanasia easily because everyone must consider the objection that perhaps a sudden cure for an individual’s illness could be discovered. There are many newly discovered researches about remedies for terminally-ill patients. The reason why no one should lose their hopes.
It’s up to us whether we should use utilitarianism as the based for our beliefs in this issue. Such a policy also answers a common objection to euthanasia —which people suffering from crippling pain are not rational enough to decide that they want to die.
MORAL THEORY: A CONSEQUENSIALIST APPROACH
Ethics is the practical application of moral philosophy. That is, given the moral context of what is good or bad, right or wrong. Each theory is based upon is based upon the viewpoint of the individual philosopher and maintains within itself its philosophical consistency.
Let us first scrutinize the Consequence-based theories. This kind of theory is based on its results judging whether that particular act is right or wrong. If the action is morally right, it is the one that will produce good consequence for a particular person.
So in this case, we have to weigh the outcomes. This leaves us a moral standard like this –a good action is the one that, as it appears, to maximize our happiness.
Consequentialist theorists are being criticize because it seems that they do not attribute any value to moral agents and such. Sometimes, our rights for humanity are violated. For example, John killed Jimmy. To make up for the loss, John will create a same individual whose characteristics and personality is the same as Jimmy’s. Let’s assume that Jimmy’s life is worth 20 utiles. Things will come into our mind like “Why can I not kill Jimmy, provided that I can also make another person whose life worth is 20 utiles or measurement of goodness too or more?” Still, we therefore say that the consequentialist theory gave us a wrong result, even though we augmented it so that it assigns intrinsic value to Jimmy himself and takes this value into account in determining one’s permissible courses of action.
Yes indeed, killing someone still violates the right to live of mankind. In other words, any act that violates someone else’s rights has associated to a large net negative value of utiles which I personally think is cannot be replaced by someone.
The very important point of this particular issue is that the intrinsic cost of the act depends upon the nature of the action itself and not the consequence of it. The reason why killing Jimmy for no reason requires a greater intrinsic cost. However, if Jimmy is killed without anyone’s fault, it requires no intrinsic cost for anyone. Though the cost of life would still be.
Another thing, Consequentialism may also be criticized because it would blame people when they have made the world worse on accident. Some may feel that people can be rightly criticized for accidents, but others feel that accidents are exempt from moral consequences.
Objection to Consequentialism
- Doing the best consequences may violate the individual’s interests and rights.
- It is an impersonal theory concerned more with aggregative question of “how much” of some good there would be than with the distributive question “who” should have it.
Types of Consequence-based theories
The first one is Utilitarianism. This is a form of teleological theory that holds that an action is judged as good or bad in relation to the consequence, outcome, or end result that is derived from it. According to the utilitarian school of thought, right action is that which has great utility or usefulness. No action is, in itself either good or bad. Utilitarians hold that the only factors that make actions good or bad are the outcomes, or end results that are derived from them.
Though utilitarianism is a widely accepted ethical theory, there are a few problems inherent in its use. Utilitarianism doesn’t give that much thought to respect of persons. In fact, it is really possible that harm can be done just to achieve overall good.
For example, Joni needed some money for the operation of her sick mother. She pleaded everyone to help her but they just rejected her. So, Joni broke into her neighbor’s house and stole some money. She used this money for her mother to live longer. It just so happened that Joni promoted happiness to her by helping her dying mother to live longer. Nevertheless, she just made a sin of stealing. In this case, harm was done in the name of overall good.
Another problem is that calculating all the possible consequences is merely impossible. It is because it requires us to assign values to every action that we will make –if it is beneficial or harmful. However, it is difficult, if not impossible, to calculate our actions and to predict the benefits and harms resulting from our course of act. We all have different thoughts and feelings. One may differ from another. One may think that this action is good. Others may think that is morally bad. How do we go about comparing the value of money with, for example, the value of life, the value of time, or the value of human dignity? This is utterly dubious, I must say.
Next is Situation Ethics. This is a Christian ethical theory that was developed by Joseph Fletcher. There are three approaches: (1) Legalistic. With this approach one enters into every decision making situation encumbered with a whole apparatus of prefabricated rules and regulations. (2) Antinomianism. Over against legalism, as a sort of polar opposite, we can put antinomianism. This is the approach with which one enters into the decision making situation armed with no principles or maxims whatsoever, to say nothing of rules. (3) Situationism. A third approach, in between legalism and antinomianism unprincipledness, is situation ethics. According to this approach, all decisions should be based on love. The only absolute is love and love should be behind every intention.
Out of these three, I wanted to discuss Situationism approach. I chose this one because we discussed it in our Christian church by our very own church head in Church of God (COG), Pastor Anthony Velasco. He talks about the three types of Christian love: the philia, eros and agape.
(1) Philia. Yes, we could recognize the word Philia from Philidelphia, a state in United States also known as brotherly love. This kind of love is friendship and affectionate kind of love. A naturally-occurring kind of love between families, friends, relatives and societies. Although philia is wonderful, it too is not reliable since it is also held captive by the shifting sands of situation as well as by ours and other’s perceptions and expectations. In the Bible, Philia is not the kind of word used to commend the word love.
(2) Eros. This is the kind of love that I personally think teenagers and so is adults usually talk about. This type of love covers everything from the butterflies in our stomach and warm fuzzy feelings to strong sensual passion. It is when people smiles and say “I’m in love!” Although Eros at times might make us feel like we are on cloud nine, it cannot provide a reliable basis for building a deep and meaningful relationship since it is so fickle and dependent upon perception and circumstances.
(3) Agape. The “unconditional love.” The highest of all kind. This is the real meaning of love and was seen in the Bible. This is the kind of love we feel for our spouse, children and God. Agape was appropriated by Christians for use to express the unconditional love of God. Before agape love there was no other word to express such great love.
Link to Situation ethics is based on six fundamentals.
I do believe that Situational Ethics gives us freedom. In the way that we can choose what is the right and wrong thing to do. It gives us an authority to do something in our own will.
However, Situational ethics depends on the individual’s appraisal of situations. A person, even with the finest of intentions, cannot foresee every consequence of an action, nor realize the number likely to be affected by it.
Critics say that Situational Ethics is quite vague. In the sense that everyone will say that “The most moral thing to do is the thing that I love.” But when you outlines what “The most loving thing to do is, it says that the most loving thing to do is the thing that is the most just.” And it goes around circles.
In an era today that some have characterized as “the age of self-interest,” utilitarianism and situational ethics is a powerful reminder that morality calls us to look beyond the self to the good of all.
People have the right to die
Human beings have the right to die when and how they want to
Many people think that each person has the right to control his or her body and life and so should be able to determine at what time, in what way and by whose hand he or she will die.
Behind this lies the idea that human beings should be as free as possible - and that unnecessary restraints on human rights are a bad thing.
And behind that lies the idea that human beings are independent biological entities, with the right to take and carry out decisions about themselves, providing the greater good of society doesn't prohibit this. Allied to this is a firm belief that death is the end.
Religious opponents disagree because they believe that the right to decide when a person dies belongs to God.
Secular opponents argue that whatever rights we have are limited by our obligations. The decision to die by euthanasia will affect other people - our family and friends, and healthcare professionals - and we must balance the consequences for them (guilt, grief, anger) against our rights.
We should also take account of our obligations to society, and balance our individual right to die against any bad consequences that it might have for the community in general.
These bad consequences might be practical - such as making involuntary euthanasia easier and so putting vulnerable people at risk.
There is also a political and philosophical objection that says that our individual right to autonomy against the state must be balanced against the need to make the sanctity of life an important, intrinsic, abstract value of the state.
Secular philosophers put forward a number of technical arguments, mostly based on the duty to preserve life because it has value in itself, or the importance of regarding all human beings as ends rather than means.
Other human rights imply a right to die
Without creating (or acknowledging) a specific right to die, it is possible to argue that other human rights ought to be taken to include this right.
The right to life includes the right to die
- The right to life is not a right simply to exist
- The right to life is a right to life with a minimum quality and value
- Death is the opposite of life, but the process of dying is part of life
- Dying is one of the most important events in human life
- Dying can be good or bad
- People have the right to try and make the events in their lives as good as possible
- So they have the right to try to make their dying as good as possible
- If the dying process is unpleasant, people should have the right to shorten it, and thus reduce the unpleasantness
- People also have obligations - to their friends and family, to their doctors and nurses, to society in general
- These obligations limit their rights
- These obligations do not outweigh a person's right to refuse medical treatment that they do not want
- But they do prevent a patient having any right to be killed
- But even if there is a right to die, that doesn't mean that doctors have a duty to kill, so no doctor can be forced to help the patient who wants euthanasia.
The right not to be killed
The right to life gives a person the right not to be killed if they don't want to be.
Those in favour of euthanasia will argue that respect for this right not to be killed is sufficient to protect against misuse of euthanasia, as any doctor who kills a patient who doesn't want to die has violated that person's rights.
Opponents of euthanasia may disagree, and argue that allowing euthanasia will greatly increase the risk of people who want to live being killed. The danger of violating the right to life is so great that we should ban euthanasia even if it means violating the right to die.
The rights to privacy and freedom of belief include a right to die
This is the idea that the rights to privacy and freedom of belief give a person the right to decide how and when to die.
The European Convention on Human Rights gives a person the right to die
- Not according to Britain's highest court.
- It concluded that the right to life did not give any right to self-determination over life and death, since the provisions of the convention were aimed at protecting and preserving life.
English law already acknowledges that people have the right to die
This argument is based on the fact that the Suicide Act (1961) made it legal for people to take their own lives.
Opponents of euthanasia may disagree:
- The Suicide Act doesn't necessarily acknowledge a right to die;
- it could simply acknowledge that you can't punish someone for succeeding at suicide
- and that it's inappropriate to punish someone so distressed that they want to take their own life.
Euthanasia opponents further point out that there is a moral difference between decriminalising something, often for practical reasons like those mentioned above, and encouraging it.
They can quite reasonably argue that the purpose of the Suicide Act is not to allow euthanasia, and support this argument by pointing out that the Act makes it a crime to help someone commit suicide. This is true, but that provision is really there to make it impossible to escape a murder charge by dressing the crime up as an assisted suicide.
Euthanasia may be necessary for the fair distribution of health resources
This argument has not been put forward publicly or seriously by any government or health authority. It is included here for completeness.
In most countries there is a shortage of health resources.
As a result, some people who are ill and could be cured are not able to get speedy access to the facilities they need for treatment.
At the same time health resources are being used on people who cannot be cured, and who, for their own reasons, would prefer not to continue living.
Allowing such people to commit euthanasia would not only let them have what they want, it would free valuable resources to treat people who want to live.
Abuse of this would be prevented by only allowing the person who wanted to die to intitiate the process, and by regulations that rigorously prevented abuse.
Objections to this argument
This proposal is an entirely pragmatic one; it says that we should allow euthanasia because it will allow more people to be happy. Such arguments will not convince anyone who believes that euthanasia is wrong in principle.
Others will object because they believe that such a proposal is wide-open to abuse, and would ultimately lead to involuntary euthanasia because of shortage of health resources.
In the end, they fear, people will be expected to commit euthanasia as soon as they become an unreasonable burden on society.
Moral rules must be universalisable
One of the commonly accepted principles in ethics, put forward by Immanuel Kant, is that only those ethical principles that could be accepted as a universal rule (i.e. one that applied to everybody) should be accepted.
So you should only do something if you're willing for anybody to do exactly the same thing in exactly similar circumstances, regardless of who they are.
The justification for this rule is hard to find - many people think it's just an obvious truth (philosophers call such truths self-evident). You find variations of this idea in many faiths; for example "do unto others as you would have them do unto you".
To put it more formally:
The person in favour of euthanasia argues that giving everybody the right to have a good death through euthanasia is acceptable as a universal principle, and that euthanasia is therefore morally acceptable.
This alone does not justify euthanasia
This is sound, but is not a full justification.
If a person wants to be allowed to commit euthanasia, it would clearly be inconsistent for them to say that they didn't think it should be allowed for other people.
But the principle of universalisability doesn't actually provide any positive justification for anything - genuine moral rules must be universalisable, but universalisability is not enough to say that a rule is a satisfactory moral rule.
Universalisability is therefore only a necessary condition, not a sufficient condition for a rule to be a morally good rule.
So, other than showing that one pre-condition is met, universalisibility doesn't advance the case for euthanasia at all.
How similar can situations be?
Every case is different in some respect, so anyone who is inclined to argue about it can argue about whether the particular differences are sufficent to make this case an exception to the rule.
Universal exceptions to universal rules
Oddly enough, the law of universalisability allows for there to be exceptions - as long as the exceptions are themselves universalisable. So you could have a universal rule allowing voluntary euthanasia and universalise an exception for people who were less than 18 years old.
Euthanasia happens anyway
Euthanasia happens - better to make it legal and regulate it properly
Sounds a bit like "murder happens - better to make it legal and regulate it properly".
When you put it like that, the argument sounds very feeble indeed.
But it is one that is used a lot in discussion, and particularly in politics or round the table in the pub or the canteen.
People say things like "we can't control drugs so we'd better legalise them", or "if we don't make abortion legal so that people can have it done in hospital, people will die from backstreet abortions".
What lies behind it is Utilitarianism: the belief that moral rules should be designed to produce the greatest happiness of the greatest number of people.
If you accept this as the basis for your ethical code (and it's the basis of many people's ethics), then the arguments above are perfectly sensible.
If you don't accept this principle, but believe that certain things are wrong regardless of what effect they have on total human happiness, then you will probably regard this argument as cynical and wrong.
A utilitarian argument for euthanasia
From a utilitarian viewpoint, justifying euthanasia is a question of showing that allowing people to have a good death, at a time of their own choosing, will make them happier than the pain from their illness, the loss of dignity and the distress of anticipating a slow, painful death. Someone who wants euthanasia will have already made this comparison for themselves.
But utilitarianism deals with the total human happiness, not just that of the patient, so that even euthanasia opponents who agree with utilitarianism in principle can claim that the negative effects on those around the patient - family, friends and medical staff - would outweigh the benefit to the patient.
It is hard to measure happiness objectively, but one way to test this argument would be to speak to the families and carers of people who had committed assisted suicide.
Opponents can also argue that the net effect on the whole of society will be a decrease in happiness. The only way to approach this would be to look at countries where euthanasia is legal. However, as no two countries are alike, it seems impossible to extricate the happiness or unhappiness resulting from legal assisted suicide, from any happiness or unhappiness from other sources.
Even if you agree with the utilitarian argument, you then have to deal with the arguments that suggest that euthanasia can't be properly regulated.
Is death a bad thing?
Why ask this question?
If death is not a bad thing then many of the objections to euthanasia vanish.
If we put aside the idea that death is always a bad thing, we are able to consider whether death may actually sometimes be a good thing.
This makes it much easier to consider the issue of euthanasia from the viewpoint of someone who wants euthanasia.
Why is death a bad thing?
We tend to regard death as a bad thing for one or more of these reasons:
- because human life is intrinsically valuable
- because life and death are God's business with which we shouldn't interfere
- because most people don't want to die
- because it violates our autonomy in a drastic way
The first two reasons form key points in the arguments against euthanasia, but only if you accept that they are true.
The last two reasons why death is a bad thing are not absolute; if a person wants to die, then neither of those reasons can be used to say that they would be wrong to undergo euthanasia.
People don't usually want to die
People are usually eager to avoid death because they value being alive, because they have many things they wish to do, and experiences they wish to have.
Obviously, this is not the case with a patient who wishes to die - and proper regulation will weed out people who do not really want to die, but are asking for other reasons.
Violation of autonomy
Another reason why death is seen as a bad thing is that it's the worst possible violation of the the wishes of the person who does not want to die (or, to use philosophical language, a violation of their autonomy).
In the case of someone who does want to die, this objection disappears.
Being dead, versus not having been born
Some people say that being dead is no different from not having been born yet, and nobody makes a fuss about the bad time they had before they were born.
There is a big difference - even though being dead will be no different as an experience from the experience of not having yet been born.
The idea is that death hurts people because it stops them having more of the things that they want, and could have if they continued to live.
Someone who makes a request for euthanasia is likely to have a bad quality of life (or a bad prognosis, even if they are not yet suffering much) and the knowledge that this will only get worse. If that is the case, death will not deprive them of an otherwise pleasant existence.
Of course, most patients will still be leaving behind some things that are good: for example, loved ones and things they enjoy. Asking for death does not necessarily mean that they have nothing to live for: only that the patient has decided that after a certain point, the pain outweighs the good things.