Voluntary Euthanasia the Right to Die or Not Die

Euthanasia: Pros and Cons

Euthanasia is the most debated topic in medical circles carrying very sensitive ethical and moral implications to it. While by no means can the right to put an end to life be considered a rightful decision sometimes the plight of the patient justifies this merciful intervention. A careful study of the pros and cons of the issue is necessary to help us get a better perspective.

Euthanasia is a Greek word which means painless death. Euthanasia is the medical term for ending the suffering of the patients who are terminally ill with unbearable pain. It has been the most debated topic in medical domains stirring conflicting views about the acceptability of the procedure. 'Fear factor' is at the root of both sides of the argument. While it is the patient's fear of the unbearable pain of the illness and loss of self dependence that explains the ultimate decision to give up life, from a different perspective there is also the fear of the doctor's abusing the power. While the issue is still under heavy debate some countries have already legalized euthanasia. An overview of the ethical, legal and moral perspectives and a careful analysis of arguments that are in favor of and against euthanasia would provide us with a better insight into this controversial issue.

Euthanasia (Different Forms)

Euthanasia literally is 'physician assisted death' which delivers the patient from his irreversible sufferings. Euthanasia can be classified under two different categories namely voluntary or involuntary euthanasia and passive or active euthanasia. Passive euthanasia refers to 'letting go' or leaving the patient to die by himself gradually by withdrawing life support devices. So in passive euthanasia the patient slips on to death because there is no intervention to restore his failing vital life functions. Active euthanasia on the contrary involves administration of a lethal dosage of sleeping pills or painkillers. So in the former case 'something is not done', while in the latter 'something is done' to end the life of the patient. [Pregnant Pause]

Euthanasia is further classified as voluntary and involuntary. Involuntary euthanasia is done without the consent of the patient and is done only on terminally ill and unconscious patients. Such a decision is taken because the patient fails to respond to any type of medical therapy and prolonging the agony would only mean continuous existence in a vegetative state. Voluntary euthanasia on the other hand is done at the request of a terminally ill patient who could no longer put up with the unrelenting pain and suffering.

In some countries such as Holland and Belgium voluntary euthanasia is a legalized procedure. However there are some preconditions, in particular a stipulated time frame till which time medical treatment must be continued before doctors resort to euthanasia. This problem assumes importance particularly when the terminally ill patient reaches a comatose stage. The World Federation of Die Societies' has opposed this concept of time frame saying that, "not only calls on doctors to make an unreliable prediction, but prescribes a pointless time limit: The longer the life expectancy the greater the patient's suffering. The essential elements for legislation are that the condition is irremediable by medical treatment and the suffering is intolerable to the patient."[Eric Gargett]

Voluntary Euthanasia [a rightful solution?]

The issue of voluntary euthanasia arises when a chronically ill patient requests for physician assisted death unable to bear the sufferings. For such patients who have no possibility of recovery from their illness and no remedy from the excruciating pain that are invariably associated with end stage diseases euthanasia offers the only hope of relief. Particularly for older patients it seems rightful to put them out of their misery instead of seeing them suffer from irreversible complications. Prolonging life under such painful and incurable medical conditions seems a futile exercise if the quality of life cannot be improved. Pro-euthanasia group argue that there is no merit in sustaining a patient if his sufferings cannot be alleviated. This is further complicated by the treatment procedures which are very painful. So under such circumstances, where there is gradual deterioration of bodily functions without any possibility of medical relief, it would only be a rightful alternative to end the misery of the patient by administering euthanasia, if the patient had opted for such a solution.

There is one more issue to be dealt with in continuation of the above discussion. It would be a violation of the patient's individual liberties if treatment is continued against his/her wishes. Further, the expense of the intensive care is also a matter of concern especially when there is no hope for recovery. As Dr. Jennet put it, "It may be: unnecessary because the condition is beyond influence; unsafe because the risks of complications outweigh the probable benefits; unkind because the quality of life afterwards is unacceptable; unwise because resources are diverted from more useful activities" [Jennet B]. So far the discussion has been centered on pain as the major factor that prompts patients to request euthanasia. However there are other factors that also affect the patient's decision such as the loss of autonomy and the increasing dependence on others for their personal needs. Research has revealed that loss of autonomy and dependence creates a distressing effect on the patient prompting them to opt for euthanasia.

Autonomy

Another rational argument that supports euthanasia is the superiority of autonomy over medical advice in deciding upon the course of treatment. Since any medical procedure these days is subject to 'informed consent 'of the patient, why should the case of euthanasia be sidelined. That is to say that if the patient is uncomfortable with the treatment that he/she is receiving and wishes for it to be withdrawn or even more specifically, requests for a lethal dosage to end her agony, it must be granted with due respect to his/her autonomy. Thus the patient's wishes cannot simply be overridden either by the physician or even the close members of the family.

Given the technological advances that we have today it is possible to sustain the life functions of the patients by artificial means for a greater period of time than that was possible in the past. However if such intrusive life sustaining treatments does not provide an improvement in mental functions it would only amount to prolonging the painful agony for the patient against his own wishes. Under these circumstances the patient has the right to discontinue the intrusive life support system and tormenting existence that it brings. So the patient's own wishes must be the first priority, even overriding medical advice. So far we have looked at the arguments that supported euthanasia. Let us now look at some issues raised by the anti-euthanasia group [Richard a. Epstein]

Anti-Euthanasia [Improving Palliative care]

The main argument put forward against euthanasia is that the request for death may more often be a 'cry for help'. An analysis of the statistics of the 'end of life concerns' of patients who chose euthanasia in the state of Oregon for example indicates that it is not the 'fear of pain' that prompts the final decision as much as the loss of autonomy and the quality of life. In these cases, it is clearly obvious that euthanasia was chosen more on the grounds of autonomy than on the grounds of compassion, which certainly poses serious questions about the quality of palliative care. It is an indication of a disturbing development if our elders facing terminal illness cannot be provided with proper palliative care. When our elders and people with interminable illness and other serious disabilities are so much bothered by the loss of autonomy (more than pain) it is indicative of the poor social structure that we are in. The world health organization views palliative care as a total care of patients including, "Control of pain, of other symptoms, and of Psychological, Social and spiritual problems is paramount. The goal of palliative care is the achievement of the best possible quality of life for patients and their families." [WHO]

So providing emotional support is as much important as medical treatment and hence efforts must be oriented towards improving the physical, mental and emotional well being of patients receiving treatment for terminal illness. In short, if medical treatment is infused with loving care for patients who are facing chronic illness they may more likely prefer to live rather than resort to euthanasia. For in most cases facts collected from the hospice environment indicate that,"The Hospice experience generally is that quality of life which seems completely inadequate to the healthy onlooker is in fact almost always valued highly and clung to tenaciously" [Twycross RG].

Further, doctors are clueless in distinguishing between genuine requests for euthanasia from requests spurting out of temporary discomfort. Given the fact that even temporarily excruciating pain can sometimes break up the will, it is really a difficult decision for the physician to make. That is to say that under these circumstances the propensity to escape from pain is so dominant so as…