Paper Presentation on
Euthanasia
Presented
By: Joseph Lalrinawma
1. Introduction:
A situation of a person
determines what s/he should act and how s/he should response to what s/he comes
across. In many cases, the context determines what is ought to be done. But
there are cases where it is really confusing to know what is to be done and
what is the right thing to be done. One instance may be for the case of
Euthanasia. It is always difficult to say who has the authority over life.
Should life be given utmost respect by preserving at all cost? Or should
there be limit? Where the limit should be drawn? Who will draw the limit? There
could be endless debates in the case of Euthanasia and this paper tries to
bring out what are the ethical issues in Euthanasia and what its consequences
are.
Definition
Euthanasia, also known as Mercy
Killing, comes from the Greek word ‘
’euqanatos’
meaning good death. It is mostly used in the medical science for mentioning
intentional killing of human being for the purpose of ending suffering or of
removing some burden.
However this should not be misread to be very limited for it also covers
incidence like where a person meeting with accident request some passer-by to
end his/her life and is killed and a soldier asking his/her friends to die at
their hands rather than due to the sever injury because of war and lost his/her
life. The decision making does not always falls at the hand of the patient or
victim but also at the hands of those who support the patient or victim to
prolong his/her life.
We
may also say that Euthanasia is an allowed death. There may be cases where the
life of an individual could be preserved even though there is no more hope of
improvement. In such case a person may be allowed to die away rather than to
suffer for long or than to be a cause of sufferings for others.
Euthanasia is also known as
assisted suicide, physician-assisted suicide (dying), doctor-assisted dying
(suicide), and more loosely by which they meant to take a deliberate action
with the express intention of ending life to relieve intractable suffering.
Some also defined it as the practice of ending a life in a painless manner.
2. Euthanasia in History:
Euthanasia is not a new thing which comes up
recently. It rather was practiced in ancient times and has been debating issue
from time immemorial. The first recorded use of the word euthanasia was by
Suetonius, a Roman historian, in his De Vita Caesarum- Divus Augustus (The
lives of Caesars- the Deified Augustus) to describe the death of Augustus
Caesar.
In
medical science, it was first used by Francis Bacon in the 17
th
century to refer to an easy, painless, happy death. Hitler had executed
hundreds of thousands of mentally or physically handicapped persons of his own
nation claiming that it was for their own good.
Euthanasia is mentioned in the Hippocratic
Oath in which the original oath states, “
To
please no one will I prescribe a deadly drug nor give advice which may cause
his death”
.
The 5
th Century BCE- 1
st Century BCE witnessed the
Ancient Greeks and Romans who supported Euthanasia and even allow voluntary and
involuntary killing. After the coming of Christianity, Euthanasia was regarded
as against to biblical teaching and strongly condemned which resulted the
reduction of its practice. With the coming of the 17
th and 18
th
Century, the Christian condemnation of Euthanasia was in turn challenged by the
Renaissance and Reformation writers.
An anti-euthanasia law was passed
in the State of New York in 1828. It is the first known anti-euthanasia law in
the USA. The Great Depression of America in 1930s experienced a tragic
incidence as the people pleaded for being killed due to their sufferings and
the notion was revived.
This
resulted to the founding of Euthanasia Society of America in 1938. It has its
agenda the legalization of euthanasia “to allow the incurable sufferers to
choose immediate death rather than wait in agony”
. Doctor
assisted suicide became legalised in Switzerland in 1937, as long as the doctor
ending the patient’s life had nothing to gain.
3. Different types of Euthanasia
Euthanasia has been divided into
many ways, Some of the most common divisions are as follows.
3.1. Positive Euthanasia
Positive euthanasia refers to the
institution of ‘therapies’ and actions designed to hasten death. This is often
known as the ‘Mercy killing’. A clear example of this would be giving lethal
injection of a dose of morphine. The direct intention of a positive euthanasia
is to put an end to the patient’s life which is brought up or carried out by
some positive lethal actions. The chief motive proposed by the supporters of positive
euthanasia is ‘Compassion’ or ‘Mercy’. But the action taken out in the name of
compassion and mercy is deliberate and direct termination of a patient’s life
which could be said as direct intentional killing of a person suffering by the
doctors, nurses, patient’s relatives or friends. This is why it is also called
as euthanasia by commission.
3.2 Negative Euthanasia
By negative euthanasia, it meant
the planned omission or withdrawal of treatment that could prolong life. The
term itself is used with different meanings. Sometimes it is used to connote
allowing nature to take its course or in other word, to let what ought to be,
be as it ought to be rather than using immoral means to prolong life. It is often used in situation where there is
very less hope or the absence of hope in curing the patient again. So one may
choose to terminate the treatment and let nature to take its course. It
involves direct intention to shorten life through planned withdrawal or
omission of life prolonging treatment. The direct intention here is not to
prolong suffering which is considered opposed to the idea of dying with dignity
and peace and this is done by means of deliberate omission of even ordinary
treatment.
3.3 Direct and Indirect Euthanasia
The difference between the direct
and indirect euthanasia lies in the level of directness in the action and that
of intention. Direct euthanasia stands for an action or omission which caused
the death of a patient in order to eliminate suffering
and indirect euthanasia stands for providing treatment that reduces the pain
but hasten the death of the sufferer.
In direct euthanasia the life is taken away deliberately sometimes even by
adding the pain but in indirect euthanasia the pain is relieved but for good.
We should also note that some writers had equated passive euthanasia with
negative euthanasia and mean by it a voluntary/deliberate omission of ethically
obligatory life preserving action.
3.4 Voluntary and non-voluntary Euthanasia
Euthanasia whether active,
passive or direct, if done with the permission or will of the person is called
voluntary euthanasia. If the same is done without the consent of the person it
is known as non-voluntary euthanasia. Passive, negative and indirect euthanasia
can also be voluntary or non-voluntary depending on whether consent is given or
not. If the state felt the need of terminating the lives of the handicapped by
terming them as ‘worthless’, it is called compulsory euthanasia. Since 2009,
Voluntary euthanasia has been legal in Belgium, Luxembourg, The Netherlands,
Switzerland, the states of Oregon (USA) and Washington (USA)
3.5 Prenatal, postnatal and adult euthanasia
The difference between these
three forms of euthanasia lies at the age of the person. If the life of a
person is terminated before his/her birth, it is called prenatal euthanasia. If
the same is carried out after the birth during the stage of infancy, it is known
as postnatal euthanasia and if the person is not a foetus or infant it is known
as adult euthanasia. It is sad to bring out that we are living in a country
where prenatal and postnatal euthanasia is most practiced. With the help of
amniocentesis, the parents could know the gender of a child in the womb and
when they came to know that the child is female, the parents aborted the
pregnancy in many cases. Also after the child is born, if there is any
deformity that could be a defamation for the parents in the society, they tend
to terminate the life of the child and put an end to his/her life.
4. Ethical Issues
4.1 Sanctity and inviolability of human life
The Bible presents life as a gift
of God, our creator and it is based on the idea that human beings are created
in the image of God (Gen 1:26-27). Job 10:12 opined that human’s life is under
the protection of God as it is so precious that God had sent His/ Her only son
to die so that the lives of human may be saved (John 3:16) and that they may
have life in abundance (I John 4:9). Therefore human’s life is not a mere
physical and biological reality but essentially an ethical and religious
reality, characterised by the unity of body and soul which are destined for
eternal life. So the Church mostly advocated the inviolability of human’s life.
Pope Pius XII even states that all human beings even those in the womb have the
right to life directly from God and not from their parents or from any other
human activity.
The second Vatican Council also had strongly
made a statement which calls all attack on human life as a criminal act. This
includes abortions, euthanasia, genocide and even wilful suicide.
The problem here is,
Should we let the
patient suffer always even if we know that they could not bear it through?
4.2 Dominion and Stewardship
God alone is considered to be the
author of life and death. It is Him/ Her who take and gave life (Deut. 32:39). Therefore,
there could be no one who could claim authority over the life of anyone and to
make judgement about it. The bearer of that life also does not have any
authority over his/her own life for it is not his/hers but rather s/he is just
a mere steward who took care of God’s property. Human being is endowed with the
right to live a life but not with the right to have dominion over it. This,
therefore, implies that human has no authority to make judgement upon what s/he
does not own. It is not a simple judgement that could be passed but rather a challenge
to the authority of its owner, God.
4.3 Prolonging life: duty and its limits
At the above point we stood for
the notion that we have no rights to take away the life of human for it is not
our own but rather we have to preserve it. The possible question here is ‘To
what extent?’ Should life be preserved at all cost regardless of the situation
and the context? It is necessary in all circumstances to have recourse to all
possible remedies? Are there any limits to this duty? We may have to say that this
duty is limited by moral law because there may be incidents where putting a
life to an end is very much needed with no other option left. Therefore we may
have to put in out by saying that it is not always an obligation to preserve
life at all cost.
4.4 Killing and allowing to die
Many scholars had argued that using
extraordinary means and thus allowing a patient to die by letting nature take
its course is the same as active killing. The stand in this opinion is that the
act may differ but the moral is the same. By active killing a person may drown
a child in a tub by putting the child’s head in the water. By ‘allowing to die’
a child may bang his /her head and fall unconsciously in a tub with his/her
head fully dipped and the person who sees the situation does not help but let
the nature take its course. The action is not the same but in both the case the
person is allowing the cessation of life. So the argument is the moral is same
due to which euthanasia, as allowing dying, is also an act of killing or in
stronger word, an act of murder.
Moreover the constitution of
India is against life taking. ‘Right to life’ is a natural right embodied in
Article 21but 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 physicians’ duty to provide
care and not to hurt patients. If euthanasia is legalised, then there is a
grave apprehension that the State may refuse to invest in health (working
towards Right to Life).
4.5 Life support
Very close to the above point is
life-support issue. The uses of respirators and feeding the unconscious patient
artificially to support may be useless in many cases but only a burden for the
family. The patient may be in a situation where there is 0% hope of recovery or
with a complete knowledge that the patient will die after the life-support is
ended. In such case, will it be very ethical to hold the life of the patient
just to let the body breathe but with no longer hope of any positive change?
Life support systems are mostly very costly and demands investment of huge
amount of money. The family may struggle a lot to keep the life of the patient
and are in danger of being bankrupt. So, will it not be more ethical to take
away the supports and let nature take its course?
4.6 The
Right to die
This has been a notion of endless
debate from long time back. Is an individual having the right to die? There
arises question whether one has the moral right, on account of some incurable
and painful disease from which s/he is suffering, to ask for death or to
consent to his/her being killed as an act of mercy. This had been what the
euthanasists are trying to achieve so that an individual may have authority
upon his/her own life.
Meanwhile
euthanasia opposers argue that if we embrace ‘the right to death with dignity’,
people with incurable and debilitating illnesses will be disposed from our
civilised society. The practise 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 dying.
4.7 Quality of life
Only the patient is aware of what
it is like to experience intractable (persistent, unstoppable) suffering; even
with pain relievers. Those who have not experienced it cannot fully appreciate
what effect it has on the quality of life. Apart from physical pain, overcoming
the emotional pain of losing independence is an additional factor that only the
patient comprehends fully.
So the ethical question that could be raised is, ‘Is it not ethical to let the
sufferer decide his/her fate?’ If this is to be taken into consideration,
voluntary euthanasia should be legalised. On the other hand, the ownership of
the life, if laid on God’s hand will negate this response.
4.8 Love and compassion
A darling pet, if severely
injured because we want to show our compassion and love for it. We do not want
our loved one to suffer for long. We have the desire to put their sufferings to
and end very soon. Why can’t the same be applied to human whom we loved? We
will, most probably, love the human kith and kin rather than our pets. But how
will we allow the pet to be freed from suffering while we could allow the human
to remain so that s/he may suffer more?
4.9 Care
Earlier majority of the sick 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 the extent of bring
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,
etc., it is now debated in term of care. .
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 utilised 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, which the
symptoms can be controlled, now and in the future, many do not want euthanasia
anymore.
5. Conclusion
Life is valuable in all ways and
should be preserved. But there may be a time where the cessation of life may be
more valuable for the sufferer. A fatally injured soldier in hard-core area may
plead his friends to end his life as an act of mercy. In such case, it is
difficult to choose what to do and what not to do. There could be no specific
answer in this for it will depend on the situation and upon level of morality
which the others have had. But for Christians, life is not what we have but
what we are endowed to take care. So no life is worthless. Life must be
preserved in all sense for there is always a room for miracle in the faith of
Christians.
