Name: Mark Gilbert Hogben

Voluntary and Non-Voluntary Euthanasia:

Is it ever permissable? Is it ever obligatory?

Professor: Dr. Robinson

Class: Philosophy 241/3 Section 51

Date Due: Thursday, February 14, 1990

The term euthanasia defined as the intentional ending the life of a suffering person, to end that suffering, although thought to be simple is really quite complex. While, I believe in euthanasia, belief in euthanasia is not as simple as believing in or not believing in mercy killing. However in the consideration of a thousand cases, the person who believes in euthanasia, would not necessarily say that euthanasia is justified every time, likewise it would be rare to find a person who states that euthanasia is totally and always wrong.

One justification given in class for voluntary euthanasia is as follows:

1. If an action promotes the best interests of everyone concerned and violates no one's rights, then that action is morally acceptable.

2. In at least some cases, active euthanasia promotes the best interests of everyone concerned and violates no one's rights

3. Therefore, in at least some cases, active euthanasia is morally acceptable.

 

Although I believe this argument is valid both logically and ethically, I would like to develop it one step further and state it as I think society should view euthanasia.

1. If an action promotes the interests of the patient as the patient stated in a legal living will, then that action is morally acceptable.

2. In some cases, active euthanasia promotes the best interests as stated in a legal living will.

3. Therefore, in some cases, active euthanasia is morally acceptable.

 

My belief in euthanasia stems from the rights of personal autonomy, our right to choose, the rights of the individual. In a poll conducted February 1990 in the United States for TIME/CNN by Yankelovich Clancy Shulman, 81% of those surveyed said if a patient is unconscious but has left instructions in a living will, the doctor should be allowed to withdraw life-sustaining treatment, 57% believe it is acceptable to go even further and administer lethal injections or provide lethal pills. I belong to that 57% that believe it "acceptable", in fact I think we have a moral duty to uphold the legal documents that clearly state that heroic measures are not to be used or that at some time a request will be issued for aided euthanasia. If there is no "living will" so to speak, then I think that the state has the right to implement heroic measures and life support systems and this right of society supersedes the right of the family. This paper will consider voluntary euthanasia, present arguments for and against.

My modified proof as stated above for voluntary euthanasia does not account for involuntary euthanasia. In the case of involuntary euthanasia I will again emphasize the rights of the individual. If an individual has not asked for euthanasia, then it should not be performed whatever the reason. It is clear to imagine abuse of any system that gives the right of euthanasia to the state.

There will be no discussion of economical advantages or disadvantages of euthanasia in this paper, because luckily for us we live in Canada, and the financial burden of hospitals is a lot lighter than in most other countries.

Why should society grant a person the right to suicide? Since death is not an experience any one person has any long-term experience with, it remains a mystery and should be left to the individual. As Socrates put it.

Either to be dead is not to exist, to have no awareness at all, or it is, as the stories tell, a kind of alteration, a change of abode for the soul from this place to another.

No one has the right to make a choice about death, unless it is one's own death. Back in Socrates' day, man did not have much control over death by disease; one got sick and died. Today however, the ways of modern science enable us to do miraculous things, such as prolonging life, and some would argue prolonging death. This can best be demonstrated by individual cases.

In my family on my mother's side, breast cancer has been passed matriarchically from generation to generation. When my mother was 10 years old my grandmother (her mother) developed breast cancer and died quite quickly, but even with the abruptness of my grandmother's death her children were scared with the memory of their mother in such a state that she could no longer recognise her own children. The only thing that modern medicine was capable of at the time was minimizing the pain my grandmother felt. My mother was diagnosed with breast cancer in 1976. Due to modern medicine the cancer was detected at the earliest point of growth and a mastectomy was performed removing her breast and part of the muscle tissue in her arm. The operation was a success, and it was eleven years later before the breast cancer re-appeared, this time throughout her body; but again it was detected at its earliest point, and she was then subjected to various chemotherapy medicine and hormonal treatment to retard the growth of the breast cancer cell tumours sprouting up on her spine and elsewhere. I am twenty-three now, and I owe my childhood with a mother to modern medicine, and it is modern medicine that continues to prolong my mother's life. However coupled with development in modern medicine come new responsibilities and decisions to be considered, one of them being euthanasia. As my mother's life continues, it becomes less and less bearable as the pain and nausea from both the cancer and the harsher treatments continue, at a certain point she may decide to end the treatment and take her own life. If this action promotes the interests of the patient as the patient stated in a legal living will, then that action is morally acceptable.

There are three common arguments against this decision of suicide, or mercy killing. The argument from nature, the argument from self-interest, and the argument against practical effects.

The Argument from Nature

The first argument against euthanasia is the argument that it is natural for all of us to prolong our lives, to protect ourselves from death, like all other animals in the animal kingdom.

It is enough, I believe, to recognize that the organization of the human body and our patterns of behavioral responses make the continuation of life a natural goal. By reason alone, then, we can recognise that euthanasia sets us against our own nature.

 

From this we can conclude:

1. Humans have a natural goal to continue their life.

2. Natural goals are morally right.

3. Euthanasia goes against the natural goal of continuing life.

4. Therefore, euthanasia violates the natural goal and is morally unacceptable.

 

This argument by Ray V. McIntyre is cited by J. Gay-Williams, and McIntyre states that it is our natural goal to prolong life, therefore we should always prolong life. This argument is not convincing because as soon as he says that natural goals should be followed, it could be argued that we should not use contraception for example, because it is our natural goal to reproduce. Also the natural goal of avoiding pain conflicts with the natural goal of prolonging life. He doesn't state how one natural goal should be more respected than another. Also premise 3. is not necessarily valid, one might argue that natural goals are not always morally correct, some might say that greed is a natural goal. Not all people would agree with greed being morally correct.

The Argument from Self-Interest

J. Gay Williams claims that if you are not convinced by the above argument he has more. One is that doctors make mistakes and you can't always be sure that a situation is hopeless.

When Cole's wife Jackie suffered a massive brain haemorrhage four years ago, the blood vessels in her brain ruptured and she fell into a coma. "The vast majority of patients who have this kind of stroke die within a few hours," Dr. Tad Pula, the head of Maryland General Hospital's division of neurology, told Cole. But Jackie did not die right away; after several crises she stabilized into a vegetative state, which doctors said could last indefinitely. After talking with his children, Cole went back to court to remove the respirator. But Baltimore Circuit Court Judge John Carroll Byrnes stayed his decision. Six days later, Jackie Cole Woke up, and now functions suffering only some short-term memory loss.

 

This example demonstrates the following:

1. The basis for euthanasia in not always correct i.e. doctors sometimes wrong

2. The decision for euthanasia is irreversible

3. It is against our interests to make a final decision on something we are not sure about.

4. Euthanasia that can't be undone, and death is not certain so euthanasia is against our interests and is wrong due to unknown future.

 

It is incidents like this that J. Gay-Williams would cite in his defence of his theory. But these cases are rare, and although medicine does make mistakes it is generally quite accurate in prognosis of patients. If Gay-Williams is going to cite this minute chance of misdiagnosis, as an argument against euthanasia he should also cite the argument for any kind of surgery the doctor deems necessary at a given time. Replace euthanasia with major surgery in the above proof. From this argument it would follow that we should not believe doctors in any decision in case of a chance of error. This would mean no more major heart surgery because there is a chance you do not need it. This is neither acceptable nor practical, the argument must be modified or dismissed. He also claims that medical breakthroughs could happen at any minute to save a previously thought to be terminally ill patient. His argument is that one is giving up when one performs euthanasia and things such as medical breakthroughs and spontaneous recovery are always possible. While this is true, I think similar to deciding on major surgery the patient must weigh the pro's and con's of euthanasia, the pain and suffering against the minute chance of recovery.

Argument From Practical Effects

The third and final argument that J. Gay Williams puts forth against Euthanasia is from practical effects.

They (doctors) might decide that the patient would simply be "better off dead" and take steps necessary to make that come about. This attitude could then carry over to their dealings with patients less seriously ill. The result would be an overall decline in the quality of medical care.

The "slippery slope" or "thin edge of the wedge" hypotheses claim that mercy killing will lead to killing of mental patients, the retarded and the elimination of any treatment deemed too expensive. In a speech by Professor Patrick Derr "Medicine and Philosophy: What the Physician Owes the Patients", Professor Derr, explained in great detail German medicine leading to World War Two, and how the killing of hopeless patients was followed by the killing of mental and retarded patients, and eventually led to the killing of Jews, Gypsies, and intellectuals, in otherwords any person the state wanted to eliminate. To cite this one example and make a causal statement out of it I think is going too far. The decline in German medicine could easily be accounted for by a series of other factors, such as the move away from individualism to socialism, the rights of society. Such influential people as Herbert Spencer (1820-1903) believed in evolutionism; the belief that humans, like animals, are in a struggle for existence, and within any species the individuals that are better able to cope with their environment survive. The weaker individuals should be weeded out. The influence of Karl Marx (1818-1883) whose Socialist beliefs gave almost no rights to the individual and whose ideal was to have the state in charge cannot be ignored. These men are only a minute part of the environment that led to the decline in medicine in Germany. The affairs of a state are far too complex to attribute a national movement to one factor.

As long as we give decisions such as the right to die only to the individual, the danger that any of the attitudes towards life will deteriorate is minimal. In an essay by W. R. Matthews, he states,

The racial theories and practices of the Nazis remind us that this emphasis on the sacredness of human personality is needed today, and I should like to make it quite clear that I have no sympathy whatever with any design either to breed or to destroy human beings for some purpose of the State.

 

Matthews' statement does not conflict with only the individual having the right to euthanasia and therefore even if euthanasia was a slippery slope, the fall could be stopped simply by limiting the rights of the doctor.

Professor Patrick Derr also stated that the medical profession has a moral right to save lives and protect us and not to perform actions which go against saving lives. In Professor Derr's view doctors have a moral obligation to only perform services that help the patient. He gave the example of a patient asking for a botched hernia operation, and Professor Derr stated that the doctor can't morally give such an operation, because it would conflict with the Hippocratic Oath which the doctor swore to, to protect us. If he views a patient's request for a botched hernia as unethical, wouldn't it be immoral for a doctor to perform cosmetic surgery or a sex change operation. All of a sudden the doctor would have the rights of choosing what he deems beneficial or harmful to a patient. A doctor could easily think that a patient's ears look fine or that a patient doesn't need breast implants and should not go through with an operation and risk infection. A doctor refusing a botched hernia operation seams plausible, but it does not seem moral of a doctor to refuse cosmetic surgery. I believe that similar to the right to choose cosmetic surgery, which right is based on autonomy, patients as individuals have the right to die, the right to choose death, and the right to have someone there to aide them with their suicide. I fear a slippery slope more if we give the decisions of morals or ethics to the doctor and take them away from the individual. Professor Derr suggested a new profession to deal with abortion, euthanasia and capital punishment, but he does not show how they would communicate with the doctor or the patient. The problems of the decision would still be up to the doctor and patient and if the doctor says pull the plug, or aide in suicide, some third party is going to do that procedure and remove all guilt from the doctor and patient. Derr's theory does not conflict, or agree with my beliefs of euthanasia, if a patient demands suicide and has filed out a living will, stating that at some point he may ask for death, then it should be granted, by a doctor, nurse, third party, son, daughter or whomever.

Our society needs an increase in education on death and dying at the high school, CEGEP, and university levels. If insurance policies could incorporate legal questions concerning euthanasia into the policies, then I think a great deal of the problems and pain, and discomfort that exists today would be solved.

When Dax Cowart was critically burned in a propane-gas explosion near Henderson, Texas, he begged a passing farmer for a gun with which to kill himself. On the way to the hospital, he pleaded with the medic to let him die. For weeks his life hung by a thread. For more than a year, against his will, he endured excruciating treatment: his right eye and several fingers were removed, his left eye was sewn shut. His pain and his protests were unrelenting. One night he crawled out of bed to try to throw himself out a window, but was discovered and prevented.

 

That was 17 years ago. Cowart is now a law school graduate, married, living in Texas and managing his investments. Yet to this day he argues that doctors violated his right to choose not to be treated

This whole agonizing ordeal could have been avoided if we had legislation making a living will incorporating euthanasia legal. If Dax Cowart had stated in a living will that if at any time he requests to die and that wish of death was lasting, and he picked the duration of that treatment, a week, an hour, a month, I think that living will should be honoured. One might argue that one can't look ahead and see what it would be like, and perhaps one might think one could endure a week of pain but when it came down to it one couldn't. While that is regrettable there must be some kind of living will that must be respected. One might argue that Cowart is alive and well and he never would have been married and gone to law school if he had been allowed euthanasia to be practised. That may be true, but that decision should be up to the individual.

A common expression is that life is a "terminal disease", but no one realizes it, we are all going to die, and we should prepare for it financially and emotionally now. These decisions should be based on the best interests of everyone concerned provided no one else's rights are violated, free choice on the part of the individual as expressed in a living will.

BIBLIOGRAPHY

Gay-Williams, J., "The Wrongfulness of Euthanasia", Intervention

and reflection: Basic issues in Medical Ethics, California, 1979.

 

McIntyre, Ray V., "Voluntary Euthanasia: The ultimate Perversion",

Medical Counterpoint, 2:26-29. in Gay-Williams

 

Painton, Priscilla, "Love and Let Die", Time, March 19, 1990,

p. 58.

 

Plato, Apology, Free Press, New York, 1966, p. 96.

Smoker, Barbara, Voluntary Euthanasia Experts Debate the Right to

Die, Humanities Press International, New Jersey, 1986, p. 67.

 

Spencer, Metta, Foundations of Modern Sociology, Prentice Hall

Canada Inc., Scarborough, Ontario, 1882