Euthanasia and assisted dying are two of the most taboo and controversial topics of the modern era that have polarised society. Although more nations across the world, including the Benelux countries, and mostly recently Austria, are changing their laws to accommodate euthanasia and assisted dying, the issue is still hotly debated. 'Euthanasia' is derived from the Greek words 'EU' and 'Thanatos', which together translate to 'good death'. It is defined as the act or practice of deliberately and directly ending a person's life to relieve their suffering (NHS, 2020). For this reason, it is widely regarded as a mercy killing. There are a number of different types of euthanasia.
Firstly and most commonly, active euthanasia is when a patient is killed by a deliberate intervention to end a life. This can be done in a variety of ways; for example, a doctor injects the patient with a lethal dose of a sedative drug such as morphine to relieve pain whilst hastening death. Another form is passive euthanasia, which is regarded as the withdrawal or withholding of 'necessary artificial life-sustaining care'. An example of this may be a person with idiopathic pulmonary fibrosis (IPF), an incurable and highly debilitating lung disease that causes increasing breathlessness, who has their ventilator switched off. Without the crucial piece of machinery to maintain their survival before a transplant, the patient would die within a short period. Euthanasia is either executed voluntarily or involuntarily, by which a patient's consent may or may not be given by themselves, informed and in the right capacity, without pressure from medical staff, friends, or family. Consent by power of attorney is also valid if the patient does not have the capacity to make decisions.
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Alternatively, proponents of the Assisted Dying Bill in 2015 and Wales utilize this term commonly as they argue that it best describes the process of a doctor prescribing life-ending drugs for 'terminally ill, mentally competent adults' to self-administer in order to aid them take their own life. This may be in the form of pills, such as barbiturates, that may be taken at home. Many sources use 'assisted dying' as an umbrella term which may also include 'assisted suicide', which is defined as the deliberate act of assisting another person to kill themselves. It should be noted that these definitions differ between countries and overlap with each other. This ambiguity is a reason attributed to the confusion legally and when comparing data worldwide.
A high-profile issue across the world, the legalization of euthanasia or assisted dying has been increasingly debated in recent years. Proponent parties for the legalization are often concerned with the individuals who might benefit from euthanasia or assisted dying either because the suffering is unbearable or because they would find it reassuring to know of an option for a way out if the suffering were to be intolerable. In contrast, opponents of legalization tend to focus on vulnerable individuals and argue their interests would be harmed by new legislation (Jackson, 2019, p.940).
This essay presents both sides of the debate, evidence of support, and in opposition to euthanasia and assisted dying. It then analyses the viewpoints on legal, medical as well as ethical, and religious considerations of the argument. Subsequently, it explores the consequences of legalizing euthanasia and assisted dying and how they may affect society ultimately concluding in favor or against the prospect of legalization.
Arguments for:
Autonomy
Campaigners have utilized one of the four pillars of medical ethics, Autonomy 'respect for the patient's right to self-determination', for decades in the fight to legalize euthanasia or assisted dying. A central argument for change in legislation is the idea that people have the right to control the events of their own lives to make them as good as possible, so why should they be denied this in death?
Public support has been apparent for decades and is growing year upon year. Recent opinion polls show overwhelming support from the public for proposals calling for a change in current legislation, with 84% of those polled supporting a form of assisted dying proposals (Populus, 2019) and 73% supporting a doctor-assisted death for those with terminal illness (YouGov, 2021). Importantly, the public feelings towards the legalization of euthanasia and assisted dying are heavily weighted to one side of the argument, in contrast to a host of other political issues, conveying the public's strong sentiment towards new legislation.
Tony Nicklinson communicated by blinking and had described his life as a 'living nightmare' since a stroke in 2005 left him paralyzed with locked-in syndrome. He has fought for new legislation for years. The assurance that assisted death is an option provides a measure of autonomy and control. There have been several high-profile, emotionally charged cases just like this over decades that have struck a chord with the public which have likely contributed to the high approval for new law in the polls. It is important to mention the state of the current law which allows voluntary passive euthanasia. There are ethical arguments that question what draws the line in patient autonomy if one can choose the removal of life-sustaining drugs, yet a terminally ill patient asking to end their suffering is unacceptable in the eyes of the law.
In addition, a survey of physicians belonging to the Medical Association (BMA, 2020) concludes that 50% of respondents support a change in legislation to allow assisted suicide, which is higher than the views against it for the first time. The trend of an increase in physician support has already moved the BMA to change its stance on the issue to a point of neutrality, from opposition, in September 2021.
Compassion and Reassurance for Reducing Suffering
An example of the application of some concepts in medical ethics is acting in the best interests of a patient a concept used extensively in law and medical care. Under the ancient Greek Hippocratic Oath, it is a physician's responsibility to essentially 'do no harm'. Therefore, the act of killing a patient, even if it is at the patient's own request or benefit, would contradict one of the most venerated moral directives a doctor swears upon when entering the medical profession (Dunn and Hope, 2018, p.11-27). Hippocrates created the Oath in the 5th century BC. It sets a standard of medical conduct for an era in which no laws or litigation existed, and when healers were considered as 'near divine'. The Oath only became universal during the 19th century, prior to this, other cultures had a variety of different vows they would take before practicing medicine. For example, Charaka Samhita in India had a physician's oath. According to the research, physicians could refuse to treat people who were not favored by the king (India and Radhika, 2019). This proves that oaths were a product of sociocultural factors of the eras and countries in which they were created.
In fact, owing to the age of the Hippocratic Oath and the rapidly advancing medical technology in the modern era, the text has been changed several times or even rejected such as the US Supreme Court ruled in 1973 due to concerns that it is losing relevance in today's world. Although the aim of medical treatment is to make a patient better, rid them of disease, or end their suffering, medicine may be used aggressively to obtain this goal. Notably, the side effects of chemotherapy, a drug used to treat cancer, may last a lifetime. Due to its powerful nature, the drug can cause long-term damage to non-cancerous healthy cells in major organ systems, such as the lungs and heart. The damage may even cause metastasis to occur and form a secondary tumor years after treatment (American Cancer Society, 2020). This shows that doctors are obliged to harm patients in order to do good to them, according to the moral principle of double effect. In fact, another highly controversial example of this doctrine, abortion, is currently legal whereas it not only contradicts the Hippocratic Oath but was illegal until the Abortion Act of 1967, showing that it is entirely possible for a harmful treatment, with the moral purpose of alleviating suffering, to be legalized.
Campaigners for euthanasia and assisted dying argue that death is inevitable, but suffering should not be. In medical ethics, the principle of justice asserts that it is unjust to deny such patients the opportunity to end their pain, therefore it is argued that patients should have the right to shorten that process. Although technology in palliative care and sedation is advancing, not all patients are able to have their pain relieved in the terminal phase of their illness or debilitating disease, for example, mental anguish as a consequence of their body's deterioration. In, only 11% of hospital trusts have the resources to provide and maintain specialist palliative services 'around the clock' (Campbell, 2016). The fact that the vast majority of dying people and those close to them still have limited or no access to specialist palliative care support when they need it in the hospital cannot be ignored. Furthermore, the clinical director of Hospice, Dr. Ros Taylor, says, 'dying does not happen 9-5 and people should not be deprived of the vital care they need because specialist support is unavailable'. Patients are far from receiving proper palliative care in their final hours and may miss the precious time that could have been spent with family if they had control over their own death. Unfortunately, without sufficient funding from Government, the trend suggests that the situation will only deteriorate with an increasingly aging population. Euthanasia presents a favorable alternative to having a pleasant death at a time of a person's choosing.
Proposals of an assisted dying bill have entered the House of Lords debates for years. Most recently, Baroness Meacher's Assisted Dying Bill 2021. A particularly heartfelt account in the report featured the story of Zoe Marley, whose mother and husband had each suffered from devastating skin and colon cancer, respectively. Marley's mother had failed a suicide attempt after her cancer has metastasized from her heel to her brain. Although there were 'do not resuscitate' documents detailing her wishes in death, Marley was subjected to threats from the doctor and, like others in similar situations, faced confusion as paramedics, doctors, and police argued whilst her mother lay undignified in the cold, in agony. Ultimately, as the circumstances surrounding her death are still criminalized her body was subjected to an autopsy, which is a final insult to the family (Dignity in Dying, 2021). As this was an instance where palliative care had already failed the patient, the unpleasant ordeal highlights the necessity for a safe and controlled environment where patients can end their lives peacefully. It is widely regarded as a kindness for people to have the opportunity to say their goodbyes to their family, fully alert and conscious, rather than 'lacking dignity' as a consequence of being anesthetized on sedatives, hooked up to machines, or perhaps even comatose or vegetated waiting for the life support to be switched off a decision often made by the patient's next of kin anyway.
Religious Views
Many religions, notably Christianity, do not recognize the so-called 'right to die', believing instead that life is a divine gift, although, the Church does not oppose enabling people to die well. New research also shows that religious leaders and other opponents of euthanasia or assisted dying as being out of touch with wider public opinion. Polls the public show that 79% of religious people, and 86% of those with a disability, support a change to the law in relation to assisted dying (Politics.co.uk, 2021). The polling data is a mixture of religious and non-religious respondents, and it is essential that people participating in the public debate declare their religious beliefs. This is crucial for analysts, partly because their beliefs will influence their views but also because their religion may require them to take a particular view (Smith, 2018). This may affect the way many people think and may limit their ability to speak freely through peer pressure or 'fear of censure'. This is the case in religion and workplace culture, as some palliative carers are fearful of risking their careers if they discuss the issue (BMJ Opinion, 2019).
For decades, the consensus as far as religion goes was that euthanasia and assisted dying were sacrilegious as across many faiths, life is considered a 'gift of God', and so not something to be squandered. However, prominent religious figures, former Archbishop of Canterbury Lord George Carey and Rabbi Jonathan Romain, are in support of doctor-assisted dying and argue that nothing in the scripture directly prohibits assisting a death to end suffering (BMJ, 2021). Their partnership has openly questioned the scripture and explained that there is 'nothing holy' about agony. It throws into question: whose interest in prolonging the life of a suffering person is if terminally ill people do not wish to live out their last few months in pain? This clearly shows how a cultural staple usually so obstinate, such as religion, can adapt to new ideas whilst still adhering to its core values.
Inconsistency of the Status Quo
Another reason for the legalization of euthanasia and assisted dying is the inconsistency of the status quo in current legislation. For example, passive euthanasia is completely legal, when a doctor removes life support from a patient, this could be a feeding tube providing nutrients. Although the law is prepared to allow this, actively euthanizing a patient with an overdose of painkillers is considered illegal. Both ways are voluntary on the patient's behalf and end in their death, which is why the current law is widely seen as illogical, especially as the patient will undergo more suffering, i.e. by slowly dying of starvation. This inconsistency in the law questions what exactly about a single lethal injection makes it morally unacceptable in comparison to the passive alternatives which cause a great deal of distress for the patient and their family.
Assisted suicide provides a far more satisfying alternative, by allowing the patient to be in their home, in the presence of their loved ones. In the Netherlands, 80.6% and in Oregon, 90.2% of assisted deaths took place inside a patient's home (Oregon's Death with Dignity Act: 2017 Data Summary, 2018). Evidence from the Netherlands indicates that bereaved relatives of euthanized patients suffer less post-traumatic stress than those whose family died of natural causes (Swarte et al, 2003). Furthermore, Switzerland will not prosecute against assisted dying and consequently, an additional 50 citizens travel to Switzerland for assisted suicide double the 2014 figures of roughly one every fortnight (Dignity in Dying, 2021). This has been called 'an injustice' due to the £10,000 fee, weakening the patient's estate, along with returning family members risking prosecution under the Suicide Act 1961.
Benefit of Regulation
It is a widely known fact and reality of the medical profession that euthanasia is already practiced across the world, including. Currently, voluntary passive euthanasia is legal. However, it is likely a conspiring medical practitioner would be stripped of their medical license if they were to partake in any type of assisted dying or active euthanasia, in addition to a manslaughter or murder charge under the Suicide Act 1961, which would make them liable for up to 14 years imprisonment. Although they could be exempt under the Coroners and Justice Act 2009, which advises against prosecution if 'wholly motivated by compassion' and done voluntarily under informed consent (Lewis, 2021), doctors would be far less fearful of legal action and dismissal from their profession against what many believe to be a kindness to their patients.
People are driven to suicide when the option of euthanasia is restricted from them. Research shows that 300-650 dying citizens end their own life annually, in addition to 3000-6500 attempting to do so, outnumbering successful attempts ten to one (Dignity in Dying, 2021). Failed attempts cause great pain, disability, and shame in the survivors, with many reattempting in the following months. Duncan McArthur ended his own life in October 2009 with an overdose of medication he had stockpiled being treated for motor neuron disease, which had been diagnosed three years prior (Dignity in Dying, 2014). He had increasing difficulty whilst breathing and was suffering from insomnia. Due to the lack of a safe, legal option to end his life peacefully, McArthur's suicide led to the immediate police inquiry into the circumstances surrounding his death; which focused on his wife as a murder suspect. The interference from the inquiry meant the funeral was postponed and resultantly did not allow McArthur's family to grieve peacefully. This additional threat of a court case looming over a victim's family at a time of great emotional pain can upset the grieving process and can result in psychological trauma (Victim Support, 2019), which could be wholly avoided under proper regulation and the legalization of assisted dying.
The figures and case studies highlight the fundamental flaws of the current legislation and expose some deficiencies in the arguments of those opposed to assisted dying. Opponents offer no solution to this problem. Without legislating for assisted dying, a significant number of dying people will continue to take matters into their own hands and end their lives in unsafe, unregulated, and distressing circumstances. An assisted dying law would provide safeguarded choice, offering better protection to terminally ill people and those that care for them.
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