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 left 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”. Also, 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 according to your own choice is just a human right as someone has the right to choose his way in life. I will try to make a case in which euthanasia is ethically, legally, and rationally justified.

Euthanasia word origin

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 also many possible combinations of these. But what I am trying to argue for is called physician-assisted dying (I used euthanasia instead of physician-assisted dying throughout this article). It is active, indirect, voluntary euthanasia which also means assisting the patient in dying with the explicit and informed consent of the patient.

In this article, I will back and forth between life, death, ethics, law, and above all the responsibilities of law and especially physicians toward the patients' concerns and rights.

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 would wake up in hell and exist for eternity. 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 appreciate such a life and will 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 brought up and assume that the positive always outweighs the negative in life but unfortunately in some cases and situations that is not true.

The Four main ethical principles in medical practice

We have four main ethical principles in medical practice, which are: autonomy, justice, beneficence (benefiting others), and non-maleficence (not harming others). Let’s begin by diving into each of them.

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, we can’t do but just having consent doesn’t mean we can. The paternalistic model of patient care is outdated. We now practice patientcentred 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 to distribute what we have more equitably. We also developed triage systems to benefit and save the most lives. What we saw during the COVID-19 pandemic is evidence of it (Baker & Fink, 2020). Some of the older people who were on ventilators were weaned off the ventilators and were given to others, especially the young people. The patients who didn’t have any possible prospects in life were voluntarily giving to others who were perhaps desperately in need. That's how we have gotten more benefits to others, less harm to others, and more justice, while the patient is exercising his autonomy. I don’t think so this is something strange and 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 patients' concerns. When there is nothing we can do for the patients, 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 to it and even it is against ethical principles to leave them suffering and having painful deaths. At least we can give them to wish their last wish.

Quality of life:
The patients with amyotrophic lateral sclerosis (ALS) which is a progressive disease, the organs one by one will cease to function, become fully dependent and bed-ridden, under very bad emotional and psychological conditions, with no cure at all for and above all with no interest in life anymore. Perhaps, the only way to stop it from becoming worse is to put an end to it. Wouldn’t it be rational to die in much less pain & prevent all the bad consequences? The quality of life is over the quantity of life.

Hospice and Palliative care are not enough for some patients:
Firstly, palliative care is legal and sometimes it is another kind of euthanasia because it has a double effect. Palliative care has a double effect and hastens death because of the side effects of opioids and sedatives given to them. It’s done at the expense of the quantity of life of the patient to relieve the suffering and pain of the patient.

So, in both, they cause premature death while it is only palliative care which is legal. Secondly, sometimes the pain becomes so unbearable, that the only thing we can do is to make the patient unconscious as a result of all the sedatives and pain relievers he is administered to. In many cases, the patient has no interest in those treatments and for almost sure that they can’t make the other way because of the illness. Then, it’s our responsibility to give them the choice to choose what they want. The 2022 Data Summary by the Public Health Division, Center for Health Statistics shows that the majority (91.4%) of DWDA 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 that euthanasia and suicide are the same thing, but they aren’t indeed. In legalized euthanasia, we can rule out reversible suffering from irreversible suffering. Also, it has a cooling-off period which gives the patients time to choose when they are in a mentally stable condition and gives them time to think about their decision and its consequences.

Unlike for example those who commit suicide die a very painful, horrible death, alone and inhumane way. But while in 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 family of 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 authorities. 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.

By: Bashdar