Why we should legalize euthanasia
Geraldine McClelland was a 61-year-old lady who lived in the UK. She suffered from lung cancer and liver cancer which had metastasized from her breast cancer. She was one of those who left her own country to seek a peaceful death. She wrote an open letter before she died, and she stated the following: “I have chosen to travel abroad [Switzerland] to die; because I cannot have the death I want here in the UK”. She ended the letter with “I appreciate that it is a difficult subject, but when dying cannot be avoided, let us be compassionate enough and tolerant enough to respect choice”( Dignity in Dying, 2011).
The right to die by choice is a human right as someone has the right to choose his way in life. The following article will try to make a case in which euthanasia is ethically, legally, and rationally justified.
The word euthanasia means good death which comes from the Greek words “Eu” which means good and “Thanatos” which means death. Euthanasia is the act of intentionally ending a person’s life to relieve their suffering from an incurable disease. It has been about more than two decades since it was implemented and legalized in some countries, e.g., Belgium, Switzerland, and some states in the US, etc. There are many types of euthanasia; for instance, active/passive, direct/indirect, voluntary/non-voluntary, and combinations of these types. The to argument of this article is for called physician-assisted dying (I used euthanasia instead of physician-assisted dying throughout this article) which is an active, indirect, voluntary euthanasia which means assisting the patient in dying with the explicit and informed consent of the patient. Different perspectives on the back and forth between life, death, ethics, law, and above all the responsibilities of law and especially physicians toward the patients’ concerns and rights will be covered.
Life, according to neutral container theory, is inherently neither good nor bad, but it is the content of life which makes it a good life or a bad one. Life is not inherently valuable, or even if it has some value in itself then it is trivial compared to the content of life. We cannot define the value of life independent of quality of life (Kagan, 2007).
Just imagine how it would be if tomorrow you woke up in hell and existed for eternity in pain. Or you are born as a child with permanent bone cancer that will continue to make you suffer till the day you die. I don’t think any of you would appreciate such a life and call it a good life. Again, it will depend on the content of life, not life itself. Somehow these lines may be counterintuitive because almost all of us are encouraged to assume that the positive always outweighs the negative in life but unfortunately in some cases and situations that is not true.
We have four main ethical principles in medical practice, which are: autonomy, justice, beneficence (benefiting others), and non-maleficence (not harming others). Let’s dive into each principle.
Being autonomous:
If we look at euthanasia’s definition there are two main points, these are autonomy and beneficence. The patient gives consent to do the procedure. Giving consent can change an act from unethical to ethical, if we give or inject medications to patients without consent even in the interest of the patient then it accounts as unethical but with the patient’s consent, it will be ethical. So, without consent, nothing can be done; however just having consent doesn’t mean we can. The paternalistic model of patient care is outdated. We now practice patient-centred practice.
Beneficence, non-maleficence, and justice:
We live in a world in which we have a scarcity of resources, especially medical resources. What we can do is distribute what we have more equitably. Triage systems have also been developed to benefit and save the most lives. The COVID-19 pandemic is an example of redirecting resources to save lives(Baker & Fink, 2020). During this time there were a limited amount of ventilators available, older patients on ventilators were weaned off the ventilators. The ventilators were then given to younger patients more likely to survive. Patients that had no prospects in life and had poorer prognoses voluntarily asked to be taken off ventilators, so others may benefit. That’s how we have benefited others while doing less harm to others, and more justice, while the patient is exercising his autonomy. I don’t think this is something strange or that we are alienated from it, isn’t this, after all, the idea of charity, giving what we have to others?
Other medical ethical principles: Care, Compassion, and Responsibility:
It is the role and responsibility of physicians to do their best for their patients and prioritize their patients’ concerns. When there is nothing we can do for the patient, we should let them die according to their own choice or perhaps pass to the next stage of life peacefully and around their loved ones. There is no point in allowing them to suffer and meet a painful end to their life even if it is against ethical principles. At least we can grant them their last wish.
Quality of life:
In patients with amyotrophic lateral sclerosis (ALS), a progressive disease with no cure, the organs one by one will cease to function, leaving the patient fully dependent and bedridden, under very bad emotional and psychological conditions. Perhaps, the only way to stop the condition from progressing is to put an end to it. Wouldn’t it be rational to die in considerably less pain and prevent all the bad consequences? The quality of life is over the quantity of life.
Hospice and Palliative care is not enough for some patients:
Palliative care focuses on reducing pain and symptoms of serious conditions with or without a cure. Hospice care on the other hand is for conditions that have no cure and focuses on the comfort of the patient until they die. Hospice care is legal and can be considered another kind of euthanasia due to its double effect which hastens death because of the side effects of opioids and sedatives given to the patient for comfort and pain relief at the expense of the patient’s quality of life. Both euthanasia and hospice care cause premature death while only one is legal.
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When the pain becomes unbearable, the only action is to make the patient unconscious with sedatives and pain relievers. In many cases, the patient has no interest in these remedies as they know they will not recover from their illness. As caregivers, our responsibility is to give them a choice. The 2022 Data Summary by the Public Health Division, Center for Health Statistics shows that the majority (91.4%) of DWDA( Death with Dignity Act)Â patients were reported to have been enrolled in hospice care at the time of death (Oregon Health Authority, 2023: 12).
Euthanasia is different from suicide and has safeguards:
One of the most common questions people ask is whether euthanasia and suicide are the same thing. In legalized euthanasia, we can rule out reversible suffering from irreversible suffering. Euthanasia has a cooling-off period which offers the patients time to choose to die when they are in a mentally stable condition and gives them the time to think about their decision and its consequences. Those who commit suicide may resort to a painful, horrible death alone without being evaluated medically and mentally for a curable cause. With euthanasia, most patients choose to be around family members when they die, with dignity and compassion having a peaceful death. As the data shows 91.7% of the patients chose to die at home and 95.5% informed their family of their decision (Oregon Health Authority, 2023: 13). Euthanasia has very strict eligibility criteria and is done under the oversight and monitoring processes of other bodies of authority.
Finally, we are autonomous beings and sooner or later death will come, these are facts that should be accepted. What we want is a good life and a good death, to live and die with dignity. It is time to change and reform. What we should do is to give the choice to those who want it and deserve it.
Reviewed by: Nvar Muhammad, Basne Rauf
References:
-Dignity in Dying. (2011, December 8). Dying wish: Please talk about death. https://www.dignityindying.org.uk/news/dying-wish-please-talk-death/
-Kagan, S. (2007). The Value of Life, Part II; Other Bad Aspects of Death, Part I [Lecture]. Death. https://oyc.yale.edu/philosophy/phil-176/lecture-20.
– Baker, M., & Fink, S. (2020, March 31). At the top of the Covid-19 curve, how do hospitals decide who gets treatment? The New York Times. https://www.nytimes.com/2020/03/31/us/coronavirus-covid-triage-rationing-ventilators.html
-Oregon Health Authority. (2023). 2022 Data Summary: Oregon’s Death with Dignity Act. Public Health Division, Center for Health Statistics.https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year25.pdf
