To End a Suffering

Euthanasia (pro)

Debates regarding the ethical validity of euthanasia and physician-assisted suicide date back to ancient times. However, it is reasonably safe to say that little progress has been made towards reaching a consensus one way of the other, either within the field of medicine or the field of philosophy, through the millennia that the topic has been discussed. Largely, this stalemate can be thought of as a consequence of the multiple moral and ethical positions that human societies, and those within them, are routinely required to take. First, each of us has a moral obligation within society to aid those around us -- either by working a job or through charity -- under the condition that the other members of society must aid us as well. Additionally, one of the most central premises under which we operate our lives is that it is morally wrong to end the life of another member of society. The difficulty is that this can either be understood as a consequence of our obligation to society or as a moral maxim unto itself -- subject only to the condition of human existence. Obviously, if this notion is regarded as some independent moral law, then preservation of human life must occur at all costs. However, if our social obligation is thought to take precedence, then there must be some instances under which mercy killing or suicide is justifiable.

Even more questions arise if one ponders specifically what can be accomplished through euthanasia. Is it reasonable to kill oneself to end individual suffering? Is it reasonable to kill oneself if death is already imminent? Is it only reasonable to kill oneself given that overall happiness will be maximized in so doing? Or, is it reasonable to kill a family member or medical patient if it can be inferred that they would have agreed with the decision? With reference to the utilitarian perspective, it may be wrong to bring about a human death, unless that death prevents more deaths from occurring in the future. Overall, these represent the main obstacles to any workable laws regarding euthanasia, and the debate remains fundamentally unresolved.

Although the idea of euthanasia is very old, taking a firm stance on the issue has never been more important than today: "In recent decades, medical advances have allowed physicians to prolong life to a greater extent than ever before. While this on the surface may appear to be a positive development, many people now fear living too long in ways they would not choose: dependent upon machines, unconscious, or in terrible pain." Furthermore, "There is a broad movement within the medical community to improve the quality of end of life care, and this freedom is most aptly illustrated by the freedom granted to physicians in providing adequate pain control at the end of life; a goal which can be pursued even to the point of hastening death." This has brought euthanasia to the forefront of social, philosophical and medical discussions, more so than ever in the past. The fact remains that many individuals, unable to gracefully end their lives on their own, freely choose to have their lives ended by others; consequently, it is no-longer fully possible for a society or government to take an utterly passive position with reference to euthanasia. Passivity endorses it by allowing it to occur. Accordingly, despite the ages that the debate has gone unresolved, modern governments have essentially been forced to take a position on euthanasia and, in doing so, suffer the consequences and criticisms.

To begin with, it is important to define specifically what sort of actions the term "euthanasia" encompasses: it is commonly understood to cover passive euthanasia, active euthanasia, and assisted suicide. Passive euthanasia occurs simply when medical treatment for a serious disease or injury is ceased; thus, allowing the patient to die sooner. Active euthanasia, on the other hand, occurs when a physician or family member physically takes the life of a dying patient; usually, this would be done by giving them some sort of lethal injection. Assisted suicide involves the rational input of the patient: it demands a situation in which they have decided to die, but cannot carry-out the suicide on their own. Generally, assisted suicide would fall under active euthanasia, but this cannot be thought of as being universally true. For example, an individual might decide that they no-longer wish to receive their life-preserving medication, but also may lack the strength to physically stop the personnel who administer this treatment; such circumstances could be categorized as passive assisted suicide. So, the term euthanasia is reasonably broad since it can be applied to all of these situations. It should not be surprising, therefore, that many people have taken issue with the practice of euthanasia depending upon their particular categorization of its subsets.

Many theorists have seen fit to enter into a discussion of euthanasia from the perspective of an individual human being's right to suicide. One such group of contrasting moral and political philosophers came together under Ronald Dworkin to produce The Philosopher's Brief on assisted suicide in 2003. Dworkin et al. presented a rather comprehensive and convincing argument for physician-assisted suicide based upon the fundamental doctrines and moral positions of the United States. Central to their discussion was the notion that individual members of American society must be allowed the "most intimate and personal choices central to personal dignity and autonomy." However, this consideration must be tempered with the fact that the state is additionally responsible for the physical well-being of its citizens; in this light, the government should act to eliminate deaths resulting from ignorance or with insidious intent. Obviously, these two central considerations of the role of the state in individuals' lives come to a head with regard to the issue of physician-assisted suicide. The dilemma arises because the government must protect the lives of its citizens while simultaneously affording them the constitutional right to use or misuse their own bodies as they see fit. Dworkin et al. attacked this issue head on, and rigorously assessed the strengths of the most common philosophical and legal objections to physician-assisted suicide while offering a more morally consistent stance.

Judging from the appeal to personal liberty that the United States Constitution presents for members of American society, it seems almost undeniable that personal suicide should fall under the actions that an individual should be able to perform. After all, such an action definitively flows out of each person's particular moral, ethical, and religious stances with regard to themselves and death; accordingly, the state cannot constitutionally force anyone to choose one way or the other. However, "States have a constitutionally legitimate interest in protecting individuals from irrational, ill-informed, pressured, or unstable decisions to hasten their own death." Dworkin et al. explicitly identifies this point and subsequently deconstructs some moral positions that deny the liberty of individuals or deny the responsibility of the state.

The weakest objection to physician-assisted suicide is summarized by the philosophers: "Some deny that the patient-plaintiffs have any constitutionally protected liberty interest in hastening their own deaths." However, the philosophers note that not only is this almost blatantly false with respect to the United States Constitution, but that the courts have routinely upheld the moral rights of people to make such significant decisions with their rulings. The second objection, as the philosophers perceive it, rests on the difficulty of drawing a definitive line between those instances in which death is a well-informed or justifiable choice and when it is not. The fallback position, historically, has been to simply ban physician-assisted suicide because to allow it would be to venture into this grey area. Dworkin et al. rejects this contention as almost laziness on the part of the courts, and they argue that many decisions by the courts have already forced them to wander into this uncertain region.

Overall, the argument presented in "The Philosophers' Brief" is a strong one with regard to assisted suicide. The issue cannot be properly addressed with blanket laws because it is intrinsically linked to the individual circumstances of the patient. Certainly, it is difficult to decide when human choices are well-informed and rational and when they are not; yet, this is exactly why assisted suicide must be analyzed on a case by case basis. Is there an arbitrary element to the divisions that the law must make upon suicide? Doubtlessly. Still, haziness is inevitable with respect to moral decisions -- consequently, the laws of human beings must remain flexible if they are ever to mimic the foundational premises upon which we conduct out lives.

As reasonable as this line of reasoning may seem, many others categorically deny that there are any circumstances under which active euthanasia is ever appropriate. One author, Ronald Otremba, writes, "Active euthanasia is never morally justified. On what basis do I make this decision? First, there is the principle that life itself is intrinsically valuable. This value is independent of one's physical or mental state of health." Otremba goes on to…