May 01, 2006

Voluntary Euthanasia: A Short Essay

Introduction

Euthanasia is one of the most debated topics in the world today. While most of us accept the claim that humans have the right to life and the right to self-determination, the problem of Euthanasia gives way to the ethical dilemma of having to choose one right over the other. Those in favor of voluntary Euthanasia claim that human beings have the right to self-determination, and from this it follows that given the case where living (or rather the process of dying) becomes unbearable, it is morally justified to hasten one’s death. Those against it argue for the sanctity of life, and that it is never right to terminate the life of another person.

This essay will argue for the moral justification of voluntary Euthanasia. As such, a person suffering from a painful and terminal disease may be right in deciding to hasten his death if he finds his suffering unbearable. This critical assessment will draw from the thoughts of Glanville Williams concerning the justification of voluntary Euthanasia, and will attempt to resolve objections to his position as presented by Yale Kamisar.


Against the Slippery-Slope Argument
 
The complexity of human living obliges the reflective thinker to think beyond generalizations and to consider particularities. For this reason, it is not the case that every claim for Euthanasia is morally justified. Both Kamisar and Williams, while reaching opposite conclusions, both advance their positions regarding voluntary Euthanasia and not in regards to the form that would allow for the mercy killing of the insane or those advanced in age. However, while Williams argues that voluntary and involuntary Euthanasia cannot be argued for on the same grounds, Kamisar believes that allowing the former would provide precedence for the latter. [1] This, I believe, is an untenable position.

First, we must consider the fact that involuntary Euthanasia does not meet the condition of the proposed right of self-determination. On the other hand, we are not warranted to terminate persons who, despite their disabilities, do not consent to an act that deliberately ends their lives. The fact that some people (i.e. idiots, the elderly) may be a nuisance for us is not enough to terminate their lives anymore than killing a young and sane individual who happens to annoy many people. There are alternatives. For example, we can place restrictions on what they can and cannot do (i.e. prohibiting the insane from operating vehicles). Thus, we can arguably make the case that the act of killing someone only because he may be a burden to society is at par with murder. This cannot be compared with the case of a person who suffers from a terminal disease, and feels that he can no longer deal with the pain.

A second objection to the slippery-slope (or “wedge”) argument is that there are cases that go against the assumption that permitting one form of action will result in the gradual acceptance of more extreme measures of the same kind. Williams compares the possible acceptance of voluntary Euthanasia with the issue of sterilization. Many were concerned that permitting voluntary sterilization would lead to “a large-scale violation of human rights”, yet this was not the case in America. In fact, the acceptance of voluntary sterilization in America had an opposite effect from what the critics expected. [2] This also comes to show that Kamisar’s wedge argument cannot be supported.

The Patient’s Decision: His Capacity

While one cannot make the claim that everyone suffering from a terminal disease expresses the desire to die, we must nevertheless account for those who do. Those who suffer, seek treatment but still want to die must be considered. In such cases, we must not only consider their wish, but also that which gives rise to this desire. Upon their request for mercy killing, there is the option of probing further into the possible causes of their grief (i.e. physical pain, psychological effects of their disease, reasonable arguments presented to them). However, if the patient still wants to hasten his death, we ought to respect his decision, even if we disagree. The patient, unlike anyone around him, has immediate access (viz. his own personal experience) to the kind of pain he is enduring. Thus, not even a physician’s diagnosis can determine the meaning of the patient’s life, or the moral value of keeping him alive against his own wishes.

Contrary to this position, Kamisar holds that patients are often incapable of making a responsible decision, despite the fact that they voluntarily express the desire of hastening their death. [3] He argues that those who are drugged are incapable of making authentic choices. Moreover, Kamisar suggests that a patient “with a clear mind” still lacks this capacity given the effects of his pain. Based on these presumptions, Kamisar believes that a terminally ill patient is almost never in a position to make an irrevocable decision, such as one that results in his own death. [4]

Although we cannot ignore Kamisar’s caution concerning the irrevocability of decisions that involve mercy killing, it does not follow that the patient is completely oblivious to what he is going through. As Williams explains, Kamisar creates a false dilemma, since “there are cases where one can be sure of the patient’s consent.” [5] Therefore, even though we cannot conclude that patients always make responsible decisions, there are at least those who can and do regarding their own lives.

The Patient’s Decision: His Rights

Does this alone suggest that terminally ill patients who no longer wish to live ought to die? From what has been argued, this is not necessarily the case. Nevertheless, it is also helpful to consider the fact that the right to life has its limitations. We are all bound to die at one point or another. This is to say that when we make claims regarding the right to life, we are not supposing that we will life forever, but only expressing the reasonable wish to live a dignified life. Defined this way, it follows that the conflict between the rights to life and self-determination is resolved.

While doctors and relatives may do their best to help the patient live a dignified life, they cannot make him live forever and must understand when it is time to let go. Therefore, while doctors and relatives may be willing to commit themselves to the task of caring for the patient while he is still alive, they should also, by that same measure of compassion, respect his wishes. By this, I do not mean to undermine the value of the patient’s life, but only to affirm his right to decide that the severity of his illness has rendered his life undignified.

Conclusion

From this critical assessment, it follows that the right to die is not incompatible with the basic human desire for a dignified life, or the right to self-determination. While Kamisar presents important challenges to those who uncritically accept the Pro-Euthanasia side of the debate, his claims concerning the patient’s capacity to make an authentic choice are inconclusive. Moreover, the “wedge” argument he presents is not enough to convince his critics that allowing voluntary Euthanasia will lead to abuses. As Williams aptly demonstrates, historical facts have falsified similar claims, as in the case of voluntary sterilization in America.Therefore, while mercy killing may not be morally justified in every possible case, there are nevertheless good reasons to believe that a patient’s voluntary decision to hasten his own death ought to be respected when he can no longer endure his suffering. 
* * * * * * * * * * * * * * * * * * * * * * * * 

[1] Kamisar, Yale. “Against Euthanasia.” Ethics for Modern Life. Ed. Raziel Abelson, Marie-Louise Friquegnon. New York: St. Martin Press, 1987. p.74
[2] Williams, Glanville. “In Support of Euthanasia.” Ethics for Modern Life. Ed. Raziel Abelson, Marie-Louise Friquegnon. New York: St. Martin Press, 1987. p.94
[3] Kamisar, p. 77
[4] Ibid. p.78
[5] Williams, p.90

4 comments:

zotfest said...

This post helped me sort out my own thoughts on the subject. A couple of these thoughts I would like to share. First, I wonder why we suppose a terminal illness must be part of the equation? Obviously we could not grant this right to anyone suffering (however severely) from a finite condition after which adequate health will be restored (eg: kidney stones).

But what of those terminal illnesses with definite outcome (eg: lung cancer). The suffering is manageable (by some accounts) until later stages. The mere knowledge of impending death however can significantly reduce the patient’s quality of life. How could we determine when in the course of the disease’s progression to condone euthanasia?

Some psychological illnesses (manic depressives) can make life unbearable to some, more than any physical ailment. Some conditions are not even technically illnesses (loneliness, lack of confidence, etc). Other factors outside the person make life insufferable. Think poverty or lack of mobility. We certainly agree that these are not grounds for voluntary euthanasia.

So how do we define critical illness? or just illness for that matter?

This leads me to the questions of perception. Is the sufferer the only one in a position to judge? Obviously not. This would simply be a way of legitimizing suicide.

Perhaps the test should be to consider what any other objective person would do in a similar situation. Of course not! The answers to this test will be as varied as the number of answerers.

Even under the “perfect” circumstances – where a council of physicians, family and friends all agree with a fully rational person suffering from a well understood terminal illness that euthanasia is the right choice – many persons will find (valid) arguments in favor of prolonging life.

What I'm getting at is that there are no answers to these questions. There area only opinions. Eventually, it becomes the difference between reasons and excuses. As grim as it is, euthanasia will sometimes be the necessary, rational choice; but we mustn’t fool ourselves; it will never be the moral one. Nor does it need to be.

Sandro
Do not fear death so much, but rather the inadequate life.
Bertolt Brecht

Camardicus said...

Hey Zed!

It was nice seeing you at the parade on Sunday. The already proud Italians can now gloat ad nauseum for at least another 4 years... ah, it's wonderful, isn't it? I must say, it is great to bear an Italian name these days!

Now, concerning your comments: Thank you for your thoughts. They are, as always, quite illuminating. In regards to your first thought, I admit that I perfectly understand your point-of-view.

The issue of euthanasia is different here in North America than it is in the rest of the world. We tend to be very pragmatic in our ways. As such, we tend to emphasize human rights more than asking ourselves, "What life should I aspire to live?"

Thus, we are not so much concerned with what is right or ideal, but rather on what is useful and works best. Looking at it this way makes it clear why we value consequences so much.

From this, I guess it follows that a terminal illness is worth ending through human intervention. Curable ones (no matter how painful!) are not as convincing! (I'm not saying I agree with this because I don't! haha)

Concerning your next point. I believe that we ought not kill. I put it this way because we should never commit ourselves to the kind of view that encourages people to end their own life.

Euthanasia should not be a guiding principle. Life is, essentially, a commitment to well-being, about working on its quality and its preservation. To encourage people to take their own lives without any justification seems to contradict that.

Therefore, euthanasia (in all its forms) will always be difficult, controversial and sad. Moreover, it is simply impossible to determine the "best time" to take someone's life or one's own. No calculus can determine a person's value, right? (I hope you appreciate the rhetoric here -- haha).

Moving on... I agree with what you say concerning how and what we define as illness. Loneliness and stress are just as typical, dangerous and real as AIDS. Again, human living is incredibly complex.

We may never be able to determine the kind of answers provided by the hard sciences. Ethics, as you rightly explained in not so many words, is never clear-cut. Therefore, it would be foolish to think that something so colourful could be reduced to black-and-white statements.

All we can do, I believe, is to deal with individual cases the best we can. Each case is different, and we should learn from as many as we can remember. Conversely, I think it is a bad idea to start with absolutes and then try to make them fit every case... it just doesn't seem right to do so given the way life just happens every day.

Your next point also deserves merit. We should all be asking ourselves, "Is anyone else suffering here?" and "Would it hurt to bring in another person to perhaps shed some light to my judgement regarding my own life?" I agree that it is the way to go.

Ethics is never a solo-project, we live with others. We affect other people's lives, and vice-versa. Thus, I think it is wise to bring in other people's ideas; taking the time to consider someone else's view only enhances one's limited horizons.

Yes, it is true that a situation may generate thousands of opposing ideas, or (even worse) lead to a general consensus that may indeed prove out to be immoral. Yet, that's part of ethics too, and the dynamic character of the discipline.

Ethics, like life itself, is an ongoing process and unfinished project. As such, we are bound to make mistakes. On the bright side, we at least get to learn from them. Unfortunately, many fail to do so, and as a result, a lot of history tends to repeat itself over time. (We can't excuse that, but that's another discussion altogether!)

I'm glad you also brought up the idea of "perfect circumstances." There are obviously none. If there were, euthanasia wouldn't come up as an option to begin with (here assuming that death and suffering are never the ideal).

Now, to suggest that one should prolong one's life (and, by implication, one's suffering!) may indeed sound like a noble thing. After all, I would feel honored in being told that my life was so important and worth living. Valid enough? Definitely.

However, I think we must also identify the underlying values from each side of the debate. Now, we shouldn't limit ourselves to simply the basic "pro-life" vs "pro-choice" positions. There is also the issue of "pro-quantity" vs "pro-quality" (I hope you appreciate the way I take liberty in inventing terms! haha).

Some people value length more than they value well-being in life. Yet, BOTH aspects are cherished by all of us who love life, and that only makes it more difficult. Clearly, we don't want choose one over the other. It's a dilemma... an added strain to an already suffering person.

Therefore, tt seems reasonable (and I say reasonable) that hastening one's death will cross someone's mind. In many hard cases, it boils down to "WHO's to decide?" and not so much "what is the RIGHT thing to do?" (the latter is simply too difficult to weigh out)

Perhaps there are no right answers (at least not perfect ones so far), but only opinions. Then again, a lot of what we do in life are based on "mere opinions", ones that lead to the countless mistakes we commit from day to day.

I'd go as far as saying that a lot of what we do is not based on any reason at all, but on habit, impulse, and the like. Thank goodness for rational choices, as they may be the best things we got in many decisions we are forced to make.

So, yes, I agree that issues regarding euthanasia revolve around weighing out the best options. However, I disagree on your last point in a way. It isn't "moral" only if we reduce the word "morality" to the simple words normally associated with it.

Morality is more than just goodness, virtues ideals and duties. It is also about living in a world where undesirables occur, where unpredictable events generate "options" that hardly seem like options! Tough luck? I don't know.

All I can say is that life happens. Now, that's part of morality too, and fundamentally, what it means to be human. So, no, in a sense we aren't fooling ourselves here.

Any thoughts?

Camardicus

Anonymous said...

Hi,

I saw this post a while back and wanted to read it, but I didn't have time.

It's a difficult subject and my feeling is that the default opinion in our society has been shifting towards an acceptance of euthanasia.

A couple of comments.

1) I think you too easily dismiss the 'slippery slope' argument. The shift toward euthanasia in the West is a part of the general shift towards a more secular culture, whose values are not rooted Judeo-Christian ethics. And the tendency has been that the more libertine ethics are tolerated, the more they are practiced. The insturmental death culture in Switzerland, the Netherlands, and Belgium has gained tremendous momentum. The leading cause of death for infants in Holland is euthanasia. A significant number of British tourists to Switzerland never return; they buy a one way ticket for a suicide trip, often claiming 'despair of life' as their source of pain. Qualifying investigations are performed after the fact. Also, consider abortion, birth control, and drug use. Each was taboo fifty years ago. And now they are widespread.

2) After having read your article once, and scanning it and your comments afterwards, it strikes me that you didn't reference God at all in your argument. My understaning is that you are a Christian, so this strikes me as odd. To discuss euthanasia is to discuss life and death. What is human life, to a Christian? What makes it valuable? What differentiates a Christian view of life from an athiest, or agnostic, or Muslim, view of life? And what of death? Do Christians not have a different understanding of death than non-Christians? Are we not told by St. Paul: "If we live, we live to the Lord, and if we die, we die to the Lord" (Rom. 14:8; cf. Phil. 1:20). Can we understand life without reference to God, his loving, and his giving? Can we understand facing death and pain without reference to the Cross and Christ's Passion?

It seems to me that your argument, regardless of its merits or demerits, is not a Christian argument.

For a Christian argument on euthanasia, see:

http://www.newadvent.org/library/docs_df80eu.htm

Camardicus said...

Hey, Eric.

Thank you for your thoughts. You rightly pointed out that my arguments are not Christian ones. The essay was actually written specifically for an ethics course in philosophy, and not in moral theology.

This obviously begs the question as to why my position would change according to my audience. First, it must be said that it is not quite the case.

The question of voluntary euthanasia is a specific one. It must be distinguished from other forms, such as involuntary, voluntary but not suffering...etc. It does not always lead to the same conclusion, and this for the simple reason that every person and case is different.

What complicates further is the tension between a doctor's duty to help a patient live and a particular person's desire to die. Such things cannot be ignored, and I understand that.

Secondly, and I think more importantly, we need to keep in mind that not all of us on earth are Christians. A good argument should ring true to all of us, not simply Christians.

Hard issues affect us all. From a critical standpoint, an argument that only works for Christians is rather weak. While there is nothing wrong with learning from the sacred scriptures and historical Church, our faith cannot be used as ammo against non-Christians.

Another point that requires explication is the reality that we are now capable of keeping people alive for a lot longer than in the past. Likewise, modern science has enabled us to prolong death. When do we let go? To what extent should we go against the natural process of life and death? It is not always clear.

In regards to your first comment, I disagree. I do not take the slippery slope argument lightly, but feel that it is inconclusive. There is always a risk of abuse in anything. Rights have their limits. It is up to us to set constraints on just how far we can go without violating some other rightful claim of equal or greater worth.

Needless to say, we'll always have people manipulate the system, and abuse of it. Such technical issues, however, belong to jurisprudence, and not ethics.

All I'm saying is that there's more to life than breathing, and some people are suffering so much that they are better off dead. If they are going to die anyway, we ought to help them, even if it means killing them mercifully.

Before I go on, I'll take a look at that article you suggested.

Thank you for your thoughts,

Camardicus