The Ethical Dilemma Of Using Euthanasia

Introduction to Euthanasia and Ethical Dilemmas

Today, there are various opinions on what should be considered ethical and/or unethical. At an early age, many people learn the difference between right and wrong, good and bad, but we all tend to develop our own ideas of why something is right or wrong and/or good or bad. Although we learn these concepts early in life and develop our own opinions rather quickly, there are some situations in life that may cause individuals to feel morally conflicted. So how about a question that you were probably never asked as a child? Should a terminally ill person be able to decide how they want to leave this world? On one hand, you have the law which strictly forbids doctors from performing euthanasia, and on the other, you have people who are suffering from debilitating, crippling, terminal diseases with no chance of recovery. These patients are often in pain, incapacitated, and live in a hospital. The dilemma is, should these individuals be able to leave this world on their own terms or be forced to let their disease run its course until they pass?

Euthanasia, also known as physician-assisted suicide has several benefits for those who are terminally ill. While standing on death's doorstep, you start to think about the things you still have in your control, and the right to end your suffering should be one of them. The freedom to choose, an end to suffering, and dying with dignity, are all things that terminally ill patients should be offered. Until we are put in a position of no hope to recovery, how can we decide what is best, having never been in a similar situation?

Historical Perspective and Evolution of Euthanasia

Euthanasia is defined as, “… the act, undertaken only by a physician, that intentionally ends the life of a person at his or her request” (Pereira, J.). Many of those who fall victim to a terminal illness feel as if they have no control over what is happening to their body; though being in control and having a choice is something many patients desire. The option of euthanasia gives terminally ill patients a choice; it puts them in control. However, the ethical dilemma of using euthanasia for the terminally ill has been around since the premodern era, and still to this day individuals fail to come to a consensus on the issue. Historically, moral theorists believed that individuals had a duty to themselves; one implication of this duty was preserving life. Euthanasia, however, would have violated this particular duty, and therefore, it was condemned as an immoral act in the premodern era (Meriwether, Nicholas K.). In addition, the ancient Greek philosopher, Aristotle, believed that “… to commit suicide is to do oneself an injustice” (Papadimitriou, John D, et al.). It is believed that Aristotle felt this way, not because of his concern for ethics, but due to his concern for the ethical implications of the law. Aristotle believed that taking one’s life was unjustifiable because it went against what the law considered to be ethical behavior (Papadimitriou, John D, et al.). Here, one may ask why the law can dictate how a terminally ill patient will die? If someone is medically diagnosed with a death sentence, why are they expected to suffer until their body gives in to the inevitable? Today, the concept of euthanasia is still a conflict of interest, however, it is seen differently now than in premodern times. In the ever-evolving modern era, euthanasia is seen more as a means to end suffering. Nowadays the practice of, “. . . voluntary euthanasia and/or doctor-assisted suicide is legally available in Belgium, Canada, Colombia, Luxembourg, The Netherlands, Switzerland, and in six US States (California, Colorado, Montana, Oregon, Vermont, and Washington State)” (“Assisted Dying in Other Countries.”).

Philosophical Views and Ethical Theories on Euthanasia

In the world of practical ethics, individuals seem to agree when it comes to the idea of what is right or wrong, however, people tend to disagree when it comes to the application of ethical ideas. Euthanasia has always been a controversial topic and with regard to this the premodern philosopher, known as Aristotle, did not agree with the concept of this practice. Kant on the other hand held a conflicting perspective. Though he believed that any request for suicide disrespected a person’s rational or decision-making abilities, he also believed that an individual’s dignity must be respected. Therefore, if a person’s rational abilities were going to be compromised by an illness, which was to impede one’s dignity, then a request for euthanasia was permissible (Lacewing, Michael.). “We respect and protect their dignity by helping them die in circumstances of their own choosing” (Lacewing, Michael.). Furthermore, the ideas of utilitarianism and the right to autonomy bring forth different perspectives. Utilitarianism is defined as, “the belief that a morally good action is one that helps the greatest number of people” (“Utilitarianism.”). According to Jeremey Bentham, utilitarian behavior lies in that “actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness” (Meriwether, Nicholas K.). In other words, Bentham believed that as long as a particular action created more happiness than unhappiness, the action was morally acceptable (Meriwether, Nicholas K.). Based on the standpoint of Kant, Bentham, and the modern application of utilitarianism, euthanasia should be considered ethically permissible. This practice would allow death with dignity as well as promote the greatest happiness by giving terminally ill patients the freedom to choose how they leave this world.

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The Right to Autonomy and Legal Considerations

In addition to the utilitarian standpoint, the right to autonomy is another example of why physician-assisted suicide should be legally and morally permissible. Autonomy is defined as, “self-directing freedom and especially moral independence” (“Autonomy.”). In regard to this definition, as long as the terminally ill patient is capable of making cognitive decisions, they should have the right to decide how they want to leave this world freely. “Euthanasia is an expression of autonomy – that a competent individual should have the right to make self-governing choices, especially in the face of increasing support for euthanasia in public opinion polls” (“The Ethical Dilemmas of Euthanasia.”). An individual’s right to autonomy should be respected, therefore, the option of physician-assisted suicide should be legalized worldwide for the terminally ill. An individual’s death is a personal matter and therefore the choice should be up to the patient, not the law.

Arguments Against Euthanasia and Ethical Concerns

Although the practice of euthanasia appears to be accepted more now, than in premodern times, there are still arguments against this practice. Two common arguments opposing its use include disputes about the effects of mental disease on rational thinking and the availability of end-of-life care (Math, Suresh Bada, and Santosh K Chaturvedi.). Those who oppose the use of physician-assisted suicide due to the possibility of mental illness argue that requesting euthanasia is a symptom of the psychological disease (Math, Suresh Bada, and Santosh K Chaturvedi.). People argue, "Attempts to suicide or completed suicide are commonly seen in patients suffering from depression, schizophrenia, and substance users” (Math, Suresh Bada, and Santosh K Chaturvedi.). Those who hold this view seem to believe that when a terminally ill patient requests for a physician to terminate their life, they are suffering from a mental illness including but not limited to depression, and this disease is influencing the patient’s decision-making abilities (Math, Suresh Bada, and Santosh K Chaturvedi.). These individuals may believe that if the patient was in a competent state of mind, they would not make such a request. In addition to this view, people also argue that if the notion of dying with dignity was stressed, the practice of euthanasia would potentially be used as a way to remove the terminally ill from the population (Math, Suresh Bada, and Santosh K Chaturvedi.). According to the article, this is referred to as, “Eliminating the invalid…” (Math, Suresh Bada, and Santosh K Chaturvedi.). These individuals believe that palliative care and/or end-of-life care is all that terminally ill patients need in their last days, as this type of care provides comfort to the patient for the remainder of their life (Math, Suresh Bada, and Santosh K Chaturvedi.). When it comes to the concept of practical ethics, there will always be those who support the topic and those who oppose it. However, in particular discrepancies, the ultimate decision should be up to those who are physically affected by the issue.

Balancing Ethical Dilemmas and the Future of Euthanasia

Opposing views and possible downfalls of euthanasia are not something that should be ignored, though, they should be discussed at length and weighed against the possible benefits of the practice. When it comes to any health issue, especially terminal illnesses, psychological disorders such as depression can indeed affect a patient. This is why testing a patient’s competency level when it comes to medical decisions is of great importance. According to research, one of the most common tests for patient competency in regard to physician-assisted suicide was developed by Grisso and Appelbaum; it is known as the Macarthur Competency Assessment Tool for Treatment (Stewart, Cameron, et al.). This specific test measures a patient’s ability to communicate their choice, factual understanding of the issues, appreciation of their situation and the consequences, and ability to rationally manipulate the information (Stewart, Cameron, et al.). Though such tests are typically contexted specific, not diagnosis-specific, they do not consider brain damage or mental illnesses to determine a patient’s level of competence or decision-making ability. It is extremely important to determine a patient’s ability to understand their health status and all possible treatment options so that they can make informed medical decisions (Stewart, Cameron, et al.). Depression can affect anyone, terminal illness or not, and this should not hinder a patient’s right to self-government as long as they are capable of making sound medical decisions.

In regard to those who argue that end-of-life and/or palliative care is available for those who suffer from incurable illnesses, this is indeed an option, but it should not be the only option. Palliative care is used in hopes to better a patient’s quality of life during their final days. This type of care is used to relieve stresses as well as pain associated with the illness (Math, Suresh Bada, and Santosh K Chaturvedi.). However, what if a terminally ill patient doesn’t want to live this way for the remainder of their life, and they refuse care? According to research, a patient has the right to refuse care, which is recognized by law (Math, Suresh Bada, and Santosh K Chaturvedi.). If this is the case, why isn’t a patient’s request for life terminating services well recognized? The right to autonomy is a big factor here; how can we force someone to live out the remainder of their life in a manner that goes against their wants and wishes? The right to euthanasia should be an option for the terminally ill, as this medical service allows patients to take control of their illness and decide how they wish to handle their diagnosis.

In the world today, individuals typically agree when it comes to the idea of what is right or wrong, however, people tend to disagree when it comes to the application of ethical ideas. Euthanasia, also known as physician-assisted suicide has always been an extremely controversial topic, hence, there have always been conflicting opinions. Arguments for this practice have typically revolved around the modern ideas of utilitarianism and autonomy, though some still oppose these views. Individuals who oppose the issue argue that psychological diseases can affect an individual’s decision-making abilities. In addition to this, they also argue that euthanasia could potentially remove the terminally ill from our population and therefore palliative care is a better option. To counter this, those in favor of the practice argue that as long as a patient is mentally competent to make sound medical decisions the choice should be up to them, as they have the right to practice autonomy. Additionally, people in favor argue that though palliative care is an option for those who fall victim to a terminal illness, this service should not be the only option. People want a choice; they want to be in control of their illness versus it being in control of them. Legalizing the use of euthanasia does not mean that if someone falls victim to a terminal illness this is the only option they have; it just offers those who seek other options an alternative rather than being forced to let the disease run its course. Although physician-assisted suicide is not legalized worldwide, this practice is becoming more popular in today’s world. The terminally ill should be offered the freedom to choose, an end to suffering, and dying with dignity.