On the Morality of Euthanasia: Analytical Analysis

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Euthanasia, as defined by Stedman’s Medical Dictionary, is ‘[t]he intentional putting to death of a person with an incurable or painful disease” (Keown 25). As John Keown points out, euthanasia can be both active (performed through action such as lethal injections) or passive (halting treatment or pulling out of it) (25). When a patient appeals for euthanasia to be administered it is “voluntary”; “non-voluntary” when the patient cannot request it; and “involuntary” when a patient could have made the request but is killed anyway (25).

Regardless, all categorizations of euthanasia are focused on the intentional killing of patients(25). For this paper, this is the understanding of euthanasia which I will examine. It is important to note that this understanding is mentioned by John Keown but I will also consider the following factors constitutive of euthanasia as well: the intentional use of prescription painkillers that would accelerate death; or the withholding of life-sustaining treatment after knowing that the treatment will be ineffective or onerous despite the patient dying earlier than if that treatment would be implemented (25). With that said, this paper will examine how under the aforementioned context Peter Singer’s utilitarian approach to euthanasia is ethical and reasonable.

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Let us begin with the opposition to euthanasia. Mary L.S. Vachon and John Keown both provide counterarguments to Singer’s utilitarian critique of euthanasia. Firstly, Vachon claims that “in terminally ill people, a wish to die is a manifestation of depression and should be treated accordingly” (Vachon 319). Essentially, Vachon argues that a patient who is suffering from excruciating pain as a result of a terminal illness is not seeking to escape this pain, but rather is seeking to escape the mental anguish that is a by-product of this pain. Thus, Vachon argues for a holistic approach to patients who are terminally ill. One which would appropriately treat the desire for an early death through both the psychological treatment of the associative depression and the physical, social, and existential concerns of the patient that is confronting the inevitability of their death (320). Vachon also stresses that this holistic approach would be inter-disciplinary as it would require a combination of medical experts such as doctors and psychiatrists co-operating to treat a single patient; thus, it is critical that each professional involved understand their expertise and limitations (320). Vachon’s Hippocratic approach to the treatment of terminally ill patients who seek euthanasia is unreasonable for two reasons. Firstly, and bluntly, it is idealistic. This idealism is dangerous because it is coming from a privileged perspective. It is often difficult for individuals to fathom the reasons why patients might seek euthanasia because they are absent from the physical pain and mental suffering. Here, Singer sheds light on these causative factors: “They want to die because they are weak, constantly tired, nauseous, or breathless. Or perhaps they just find the whole process of slowly wasting away undignified. These are reasonable grounds for wanting to die” (Singer 557). The pain and suffering that terminally-ill patients suffer is profound, and in my opinion, visceral. Thus, Singer also outlines, it is easy to understand how experiencing such pain could lead to depression; and why someone would rather opt to die than continue living.

Singer’s utilitarian approach considers these factors. Firstly, it provides subjectivity to the objectivity of “that it is always wrong to kill an innocent human being” (327). As Singer stresses, the conditions that lead to the request of euthanasia are generally more negative than positive; more joyless than joyful; and more angering than calming – so if that is considered, than euthanasia can be seen as a right action because its consequences are better than or equal to any other option the patient has (529). Through utilitarianism it is clear how euthanasia would bring freedom to the suffering, and thus is a reasonable option. However, this is only the case if the euthanasia is voluntary as only the agent knows what they want and what they are feeling; as expressed in the John Stuart Mill analogy, what right do we have to restrict someone from crossing that bridge? I can think of a family’s right to want to continue seeing their loved ones, but like Vachon’s premise, such sentiments are good-hearted but more of a result of human’s inability to confront death and the result of another’s desires rather than the agent’s desires. In essence, if we are speaking of non-voluntary or involuntary euthanasia then I believe it is a highly unethical practice as each individual should have the right to make their own decision, not have their decisions made for them. Thus, the virtue of personal liberty must be upheld in order for euthanasia to be considered reasonable.

This leads me to the second reason why Vachon’s argument is unreasonable and that is because it is selfish. Vachon would rather have terminally-ill patients treated through a holistic approach that would preserve their life. But what if patients specifically requested euthanasia? It would be cruel to impose a treatment that kept them living in a state of anguish especially against their consent. The cruelty derives from the fact that patients are aware of their pain; as Singer pointed out earlier. I do not believe that associative depression masks this pain, and agree with Singer when he states “If patients can rationally opt for an earlier death by refusing life-supporting treatment or by accepting life-shortening palliative care, they must also be rational enough to opt for an earlier death by physician-assisted suicide or voluntary euthanasia” (558). Patients rationalize death as the best option because living is painful; they do not think living is painful because death is the only option. In fact, as Singer points out, depression is typically episodic (534). When a person is going through a bout of depression, they are not entirely rational as they are affected by the hopelessness it brings, but if a person goes through constant periods of depression that pain becomes normalized. However, a cyclical depression brings forth an awareness that it will recur (534). While the desire to die rather than have to go through another period of depression occurs in a “normal,” it is entirely rational as the agent feels it is unavoidable (534).

In addition to Vachon, Keown also argues that euthanasia is unethical because its practice in the medical field has been “out of control” (Keown 29). Keown essentially outlines the slippery slope argument which states that firstly safeguards to prevent voluntary euthanasia to becoming non-voluntary will be ineffective even if there is a policy that would prevent it from occurring (25). In addition, since doctors are able to make judgements that “certain patients are better off dead,” about competent patients than it can also be made in relation to incompetent patients (26). The argument holds the notion that under these pretenses the practice of euthanasia could be used to justify many requests such as the request to die because of being “tired of life.” In addition, Singer also provides two additional reasons why the slippery slope argument is prominently used. First, many believe that accepting euthanasia will lead to doctors pressuring terminally ill-patients into assisted-suicide (Singer 538). Second, patients might also be killed because they are a burden to the hospital’s resources or to their families (538).

However, Singer also points out to prove such a theory, intensive studies would need to occur. From the conclusion of the Remmelink Report based on the Netherlands which “indicated that physicians occasionally – in roughly 1000 cases a year, or about 0.8% of all deaths – terminated the lives of their patients without their consent. This was, almost invariably, when the patients were very close to death and no longer capable of giving consent” (539). However, studies since then have occurred and revealed that rates of the abusive use of euthanasia by dutch physicians have not increased dramatically. In fact, an Australian study revealed that rates of involuntary suicide were higher in Australia than in the Netherlands (a country that completely legalized euthanasia in 2002). Australian rates of non-voluntary euthanasia were at 3.5% in comparison to the Dutch rate of 0.8% (540).

In conclusion, I believe that if euthanasia is voluntary it is highly reasonable. The reason why I agree with this is because if one considers from a utilitarian perspective that euthanasia provides more benefits to terminally-ill patients than drawbacks than it is actually more ethical to reduce the amount of pain they experience than to have them live but continue suffering. However, if euthanasia is involuntary or non-voluntary than I agree that it is not reasonable because I also believe that personal autonomy is critical in the decision-making process regarding assisted suicide. However, one factor that I do not believe in is that there should be legislation that protects involuntary or non-voluntary suicide for this very same reason.


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