Ethical Issues Raised by Euthanasia in Medical Ethics
Professional ethics requires that, when exercising their skill and knowledge, the professionals abide by a code of conduct that provides moral justification of what acts may be regarded as right or wrong. This code of conduct could simply be described as a set of moral principles. These moral principles that guide professionals are based on moral philosophy. Philosophy is problematic in itself due to the fact that there exist different conflicting schools of thoughts making it impossible to have a unanimous understanding of what is morally acceptable and what is not.
One of the professions that is laden with numerous ethical questions is medical ethics. Doctors have a duty to preserve life and symbolic of this duty is the Hippocratic oath that requires them to do no harm and preserve life in all instances. These ethical principles that date back to ancient times have been adopted and have formed the basis of setting standards for professional conduct. For instance, the Hippocratic contains fundamental ethical principle that are also present in the America Medical Association Code of Medical Ethics (American Medical Association, 2016). Based on this ancient principles, it is now widely accepted that the need to have ethical standards to regulate professionals is crucial.
One of the most controversial issues that still attracts wide debate is the issue of euthanasia in the medical profession. The practice of euthanasia is illegal in most states in America. However, some states such as Vermont and California allow euthanasia. The debate on whether or not euthanasia is morally justifiable is not a new discussion. Debates on euthanasia date back ancient Rome and Greece with physician during this period suggesting that it would be merciful to give patients anaesthetics to relieve the pain of death. The physician Samuel Williams was also the first to argue for the use of morphine to intentionally cause the death of a patient. Nevertheless, there exist philosophical arguments both for and against practice of euthanasia.
Issue-ethical Issues Raised by Euthanasia in Medical Ethics
The specific issue that this paper seeks to deal with is the practice of euthanasia which raises ethical question in the field of medical ethics. Euthanasia has been defined as any action where a person is intentionally killed or allowed to die because it appears or it is believed that such a person would be better off dead than alive. It therefore follows that the practice of euthanasia has been broadly defines and involves both positive acts, such as direct killing, and also omissions that may lead to the death of the patient. Euthanasia can therefore fall into a number of broad categories. For instance, in can be voluntary, where the patient consents to their death. It can also be non-voluntary, where the patient may not be in a position to consent to their death. The doctor may also procure the death of a patient against his will in which case it would amount to involuntary manslaughter.
There are many ethical questions that arise from this practice of assisted suicide. For instance, can suicide sometimes be in a person’s best interest? Is suicide morally wrong and are there instances where it can be justified? If there are justifiable instances where suicide can be allowed, is the doctors action or omission towards assisting such suicide morally wrong? Do patients enjoy the right to die as a fundamental part of the right to live? Does the patient’s autonomy allow him or her to self-determination? This diverse challenging questions attract different conflicting arguments. The crux of the issue however is determining whether or not the patient enjoys a moral right to die.
Discussion-ethical Issues Raised by Euthanasia in Medical Ethics
Argument for Euthanasia
Ancient philosophers such as Plato and Aristotle believed that suicide was an immoral and disgraceful action. Plato argued that suicide represented the abandonment of one’s duty to live and as such it would deprive the community of a citizen. Despite the arguments of these classical natural law theorists, there existed contrasting philosophical views during this era. For instance, the Stoics of the Hellenistic and Roman eras believed that although life should be lived fully, the desire for one’s death could be justified if one loses the ability to pursue life in the nature that it was intended (Patterson , 1988).
Seneca, a Roman Stoic argued that the right of a person to self-determination is a consequence of the choices granted to us by nature. He opined that to maintain that to deny one the right to determine their own death would be similar to shutting the path to freedom. He argued that nature allowed man one entrance into life but also provided him with many exits. The sixteenth century saw many philosophers moving away from the common classical view that euthanasia was immoral and unjust. For instance, Michael de Montaigne challenged the religious prohibition of suicide and argued that the issue of suicide was not a question of religious belief but personal choice but the pain and fear of a worse death could justify such actions (Danaher, 2011).
Some of the eighteenth century philosophers, who moved away from holy law as the fundamental source of morality, supported the practice of euthanasia. For instance, David Hume argued that even if suicide led to weakening of the community, it would be justified if the good it afforded the person outweighed the loss to the society. The religious prohibition of euthanasia continued to receive criticism from a number of philosophers. John Donne, who while qualifying suicide as morally wrong, asserted that there could be instances where the practice of assisted suicide could be morally justified when it is done to glorify God and not to serve self-interest.
Modern day scholars continue to grapple with the issue of moral justifiability of euthanasia under medical ethics. For instance, Tooley argues that there exist instances where suicide can be in a person’s best interest. First, when the patient is suffering from considerable pain from an illness without a cure then the death of that person is in his or her best interest. If this patient’s death is in their best interest, then committing suicide is in his or her best interest (Cavan, 2000). It therefore follows that if a person is suffering great pain from an incurable illness, committing suicide is in his or her best interest. This argument is logically valid however, it is arguable whether or not it is morally persuasive.
Another approach that has been used to justify the practice of euthanasia is the use of arguments based on rights. Modern day scholars argue that people have the right to die and that death is a private matter if no harm is caused to others and therefore the state has no right to interfere in the matter. The basis of this argument is that the right to life does not simply mean the right to exist but also the right to a life of a minimum quality and value and as such, people have the right to make events in their life and death as good as possible (Cavan, 2000). This however cannot be interpreted to mean that in such instances doctors have the duty to kill and therefore have to provide medical assistance to the patient to the best of their skill and knowledge.
Arguments Against Euthanasia-ethical Issues Raised by Euthanasia in Medical Ethics
The ancient philosophical arguments against euthanasia are fundamentally based on the notion of preservation of God given life. Plato and Aristotle considered life as divine and as such looked down upon any attempt to deliberately end one’s life. It therefore follows that the practice of euthanasia by physicians during this era was frowned upon. The word ‘euthanasia’ in ancient Greece was used to mean ‘good death’ and had not connection with the benevolent killing of a person to alleviate their pain. Plato, for instance, abhorred the act of suicide claiming that is was a cowardly act and that it could only be acceptable if a person had an incorrigible and immoral character.
The religious prohibition of suicide was a commonly accepted in the middle ages by many philosophers. St Thomas Aquinas also strongly argued against suicide claiming that to commit suicide would be wrong as it would contravene the duty owed to oneself and the natural inclination of self-preservation. He also asserted that to do so would be in disobedience of God’s will as it would violate His authority over life. This ethical basis of the sanctity of life was also upheld by many philosophers during the age of reason. For instance, John Locke maintained that there exist natural inalienable rights that should not be taken away from individuals and such is the right to life (Patterson , 1988).
Emmanuel Kant emphasized that suicide was a direct violation of moral responsibility. He believed that suicide was inconsistent with the fundamental value of human life which to him was self-preservation and as such suicide was not a rational and moral act. Kant argued that autonomy should not be loosely interpreted to mean doing what someone wants but involves the subjugation of one’s own irrational desires to one’s rational understanding of universally accepted moral values. As such one should not be take one’s own life.
Modern day discussions have however widened the focus to include when doctors assist in the procurement of suicide and the ethical issues that surround such assisted suicide. This also includes passive euthanasia, when doctors withhold treatment which ultimately leads to the death of the patient. Some modern day opponents of euthanasia have agreed that the practice of euthanasia can, in some cases, promote the autonomy of the patient. They however argue that value of human life outweighs the need to respect the autonomy of the patient. On the other hand, there are those who maintain that there can be no autonomy to commit suicide and that the idea is incoherent. An analogy to represent this conflict would be like suggesting the ‘freedom’ to sell oneself into slavery (Keown, 2002).
Analysis and Conclusion
Assuming one is a doctor faced with a case where a patient is in great pain from an incurable disease and wishes to end his suffering through withholding some vital treatment and the two options are available to the doctor. The first option would be to provide the patient with the means to a quick painless death. The second option would be to allow the patient to live longer with the illness in pain and allowing nature to take its course. What would be the morally justifiable and ethical thing to do? What consequences would arise from each option and would these consequences be justifiable?
In my view, the argument that the patient’s autonomy could be overridden for the purpose of maintaining value of life is largely incoherent with the theory of morality. Morality in this sense does not mean divine law and therefore, the value of life in this case and in the eyes of the patient is impaired. Such a patient has the right to life, however the right to life fundamentally means the right to choose, not only how one lives, but also what would constitute a good death. It would therefore be more ethical in such a case to allow assisted euthanasia, however, this must be voluntary.
What would be the consequences of a doctor refusing to provide euthanasia to a patient in a coma who has zero chances of waking up? Is it morally justifiable to allow this patient to live off of a life support machine for the rest of his or her life? Is there no standard for which we can allow for such a doctor to withhold life support for that patient? I would argue that in fact, there is. The best interest of the patient at this point would be death. It would be morally unjustifiable to deny such a person’s request to die according to his will if the ultimate result of his illness is guaranteed death. However, despite these views, the position remains highly controversial and will definitely be the subject of continued debate.
American Medical Association. (2016). AMA Code of Medical Ethics. American Medica Association.
Cavan, S. (2000). Euthanasia: The Debate Over the Right to Die. New York: The Rosen Publishing Group Inc.
Danaher, J. (2011). The Ethics of Euthanasia. Philosophical Disquisitions, 2-6.
Keown, J. (2002). Euthanasia, Ethics and Public Policy. Cambridge: Cambridge.
Patterson , C. (1988). Assisted Suicide and Euthanasia: A Natural Law Ethics Approach. England: Ashgate Publishing Limited.