Euthanasia summary

Before I start summarising the two articles, I would like to put on the top of this work the most common description of the term “euthanasia”. So Euthanasia is: “the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma. Origin: early 17th cent. (in the sense ‘easy death’): from Greek, from eu ‘well’ + thanatos ‘death’.”1 The topic of euthanasia is one that is shrouded with much ethical debate and ambiguity. In the beginning of his work, Michael Tooley clearly describes what is his main goal, i.e. to defend the claims that first: neither voluntary active euthanasia nor assisting someone to commit suicide is in any way morally wrong; secondly, there should be no laws prohibiting such actions, in the relevant cases.

After that it is really important to make the distinction of the tree considered types of euthanasia, which are: voluntary, non-voluntary and involuntary euthanasia. Voluntary euthanasia refers to euthanasia performed at the request of the patient. Involuntary euthanasia is the term used to describe the situation where euthanasia is performed when the patient does not request it, with the intent of relieving their suffering – which, sometimes can be considered as a murder. Non-voluntary euthanasia relates to a situation where euthanasia is performed when the patient is incapable of making a decision.

After that we can see the important dichotomy of “active” and “passive” cases of euthanasia. Active euthanasia refers to the deliberate act, usually through the intentional administration of drugs, to end a terminally ill patient’s life. On the other hand, supporters of euthanasia use “passive euthanasia” to describe the deliberate withdrawal of life-prolonging medical treatment resulting in the patient’s death. We can conclude that the main difference between active voluntary euthanasia and assisted suicide is that in physician-assisted suicide, the patient performs the killing act. Physician-assisted suicide refers to a situation where a physician intentionally assists a patient, at their request, to end his or her life, for example, by the provision of information and drugs. It must be noted that euthanasia is currently illegal in most of the countries in the world, although, there are a handful of countries and states where acts of euthanasia are legally permitted under certain conditions. There are many arguments that have been put forward for and against euthanasia.

Following the article we can see the consideration of one very important side of the whole question, which is the defence of the assisted suicide and voluntary active euthanasia and later the author had contrasted it with the voluntary passive case of euthanasia. Michael Tooley gives the readers an exhaustive list of premises that are in big favour and protection of the voluntary active euthanasia and after that we can see the successful logical verification of each of them. “Provided that one does not have any obligations to others that would make it wrong for one to provide someone with voluntary active euthanasia, then the difference between helping someone to end his or her life, and doing it for that person, cannot be morally significant.”

So we can consider that every patient has the right to make the decision by his or her own about whether and how the should die, based on the principles of autonomy without causing harm to others. As every individual should have the right to control their life and make their decisions concerning death. In this case it is more than obvious, I think, that by performing euthanasia more good than harm would be done to the suffering patient. It is a famous view that the fundamental moral values of society require that no person should be let to suffer and die in suffering, instead of that merciful act of euthanasia should be permissible. And in that way the patient can peacefully reach their dignified death.

It was proven that voluntary active euthanasia and assisted suicide are not morally wrong in themselves. Tooley actually synthesised it in one perfect description of the case: “The only intrinsic difference between voluntary active euthanasia and voluntary passive euthanasia is that the former is a case of killing, and the latter a case of letting die.”3 It is a common fact that usually supporters of euthanasia claim that active euthanasia is not morally worse than passive euthanasia – the withdrawal or withholding of medical treatments that result in a patient’s death. With this view, it is argued that active euthanasia should be permitted just as passive euthanasia is allowed. It is interesting to see that in the last chapter of his article Michael Tooley is using as an example the theory of James Rachels, who is a well-known proponent of the euthanasia. He thinks that there is no moral difference between killing and letting die, because the intention is usually similar based on a utilitarian point of view.

Rachels even argues that “Historical and anthropological evidence that approval of killing in one context does not necessarily lead to killing in different circumstances” and of course we can see the usage of this argument in Tooley`s article.4 So the active euthanasia actually is considered as more humane than the passive one. Never mind the religious arguments against the euthanasia case (and they are really serious), I think that a big percentage of the reasonable persons in one society should agree that a quick and painless death (active euthanasia) is much better for one human being than a slow painful and sometimes “everlasting” process of dying, similar to torturing. So we can put a moral question here that can deal with the cases of euthanasia: Is it better for a patient to experience a quick and painless death possible with one pill, or the patient`s life must be prolongated with a breathing machine (for example) next to their until they finally die? Opponents of euthanasia argue that there is a clear moral distinction between actively terminating a patient’s life and withholding treatment which ends a patient’s life.

Letting a patient die from an incurable disease may be seen as allowing the disease to be the natural cause of death without moral responsibility. But life-support treatment merely postpones death and when interventions are withdrawn, the patient’s death is caused by the underlying disease. Central to the argument against euthanasia is society’s view of the sacred status of life, and this can have both a secular and a religious basis. The essential element is that human life must be respected and preserved. The Christian view sees life as a gift from God, who ought not to be ended by the taking of that life. Similarly the Islamic faith says that it is only God`s will to give life and cause death. The withdrawal of treatment is permitted when the condition of the patient is futile, as this is seen as allowing the natural course of death. Some sides and opinions against the act of euthanasia was just mentioned in the above rows, but now we should go deep to the other side of the topic in the case against euthanasia and see the main problems that Daniel Callahan rises in his article.

Callahan is worried about the social consequences of legalising euthanasia. He thinks that proponents of euthanasia mistakenly interpreted the decision to end one’s life (with assistance) as a private decision, and consequently as something that should be left in the zone of self-determination. We can consider that as wrong because euthanasia is necessarily a social act: something that requires the assistance of another individual. Otherwise, I mean without the assistance of another individual we can consider the act of ending ones`s life as a suicide. For example the common views of the society in a situation of voluntarily active euthanasia and in spite of patient`s consent, considers it as primordially wrong. Callahan who`s work is against the act of euthanasia describes the practice of active voluntary euthanasia as “consenting adult killing”.

Here I think is important to pay much more attention to the serious contrast of situations of killing and letting die. The reason this is important when it comes to euthanasia is that some people think that there is no problem for an individuals to refuse life-preserving medical treatment (and let themselves die), but do not think it is acceptable for the same individuals (with assistance from their doctors or families) to take active steps toward killing themselves. And that can create a case of serious moral dilemma and confusion in the society. It is a common case that euthanasia advocates are trying to exploit the openness of people to the passive forms of euthanasia when defending its active forms. They do this by arguing that there is no important moral difference between killing and letting die. As it was mentioned above the name of James Rachels is often used as a “symbol” as he was perhaps the leading proponent of this argument.

Of course unsurprisingly Callahan rejects it. He thinks that proponents of the “no difference” argument are wrong and confused, because they fail to appreciate the nature of a doctor’s decision to “let someone die”. Basically, he points out that life is fatal and that ultimately, doctors can’t prevent death, they can only postpone it. Thus, they aren’t really killing people when they are retreating the treatment, they are just making unavoidable decisions about the best use of medical resources. Probably Callahan’s analysis is a little uncertain here. There are complex issues to be addressed in determining what counts as a cause of something, and he fails to discuss those. On the other hand we can see Tooley’s argument, which opposes Callahan’s, that does not rely on this killing versus letting die distinction and so the issue can be sidestepped by the euthanasia advocates. As we proceed with the article we can find, as it was already noted one of Callahan’s primary worries about euthanasia i.e., if euthanasia is worldwide legalised, it will be add to the range of permissible killing in society.

And if we add it to the range of permissible killing, sure we will find ourselves in a very difficult and disturbing situation. He illustrates his point by a reference to a study done on the regulation of euthanasia in the Netherlands (“The Dutch experience”). Throughout the 1970s and 1980s, Dutch courts allowed certain conditions for euthanasia cases. Although the legal situation has changed more recently, it is this period that is covered by the study referenced by Callahan. The study, which dates from 1992, was an anonymous survey of the Dutch physicians who were responsible for ensuring that the conditions mentioned by the courts were being met.

Despite repeated assurances over the preceding years, the survey found that 50 percent of euthanasia cases went unreported, and that 1/3 were cases of non-voluntary euthanasia. Callahan finds this shocking and a dramatic illustration of the totally wrong road that our society can go on. Probably it is worth recalling the observation made by Tooley here: what matters here is not whether there are undesirable cases of euthanasia in the Netherlands, but whether there are more such cases than when compared to countries that don’t

have legalised euthanasia? After all, just because a practice has not been legalised does not mean it is not taking place(a lot of examples can be given) Tooley thinks that when the appropriate comparative exercise is carried out, the results lead us away from Callahan’s pessimistic view of euthanasia and assisted suicide. At the end of his article Callahan makes an interesting observation. After examining evidences from Oregon (which also had a form of legalised euthanasia) he notes that very few people actually voluntarily took advantage of euthanasia. In practice, those who suffer from painful and terminal illnesses tend to make the decision of taking palliative care, no matter how devastating their lives have become. Given the concerns he has already expressed, Callahan thinks there is no good reason to legalise euthanasia simply to serve for the needs of some minority.

It can be seen that euthanasia is indeed a contentious issue, with the heart of the debate lying at active voluntary euthanasia and physician-assisted suicide. Its legal status, prohibition and criminalisation of the practice of euthanasia and assisted suicide reflects the legal status quo and the human rights that are present in most other countries around the world. In contrast, there are only a few countries and states that have legalised acts of euthanasia and/or assisted suicide. The many arguments that have been put forward for and against euthanasia, and the handful that have been outlined provide only a very small drop into the ethical debate and controversy surrounding the topic of euthanasia. At the end we can mention the special relation between the doctor and the patient and the role of the physician. The most common opinion on this relationships is that active voluntary euthanasia and physician-assisted suicide undermine the doctor-patient relationship, destroying the trust and the confidence and of course breaks the moral code.

From the Hippocratic Oath we know that a doctor’s role is to help and save lives, not end them. But it is also true that doctors should always do what is the best for the patient, and in many cases the best thing in one patient`s “evolution” is to end their life. My personal opinion is that it is not worth living anymore if a person is not capable of remembering the name and faces of their relatives, if it is not capable of breathing by their own, if it is not capable of enjoying the gifts of nature, etc. So it is better to have a short but complete – eventful and satisfactory life, than to prolongate the death for years and to feel alive at all. Or to put it in other words, it is better when a person die, his or her love ones to suffer and weep than to rest that this person is finally gone.