First, I will deal with the moral permissibility of assisted suicide as a principle, and then I shall explore the distinction between active and passive euthanasia. Finally, I will conclude with a short discussion of the legality of assisted suicide. In the interests of brevity, I shall consider voluntary euthanasia only for individuals who are terminally ill and suffering from unmanageable pain.All arguments will be evaluated from a utilitarian and deontological perspective. The first argument for euthanasia is a utilitarian one. “Actions,” according to the utilitarian John Stuart Mill, “are right as they tend to promote happiness, wrong as they tend to produce pain or the reverse of happiness.
” If we were to apply a hedonistic calculus to the case of a terminally ill patient suffering from severe, untreatable pain, we would see that the happiness is maximized and pain minimized by euthanasia.The sort of pain caused by an advanced, terminal illness would clearly score a negative value, perhaps a negative seven. The level of pain and the progression of the disease would also render the person unable to enjoy the activities that made his life pleasurable, so there could be no higher intellectual or emotional pleasures to balance the physical pain. At best, the person continues to suffer at the negative seven; if his illness has not reached its climax, his suffering may increase. In contrast, his death will create a value of zero, and thus misery is reduced.Moreover, his family and friends will be spared the pain of watching him suffer through a prolonged illness.
Hospital space and resources will be free for patients with more treatable conditions. (Lest such concerns sound callous, it is important to recognize that utilitarianism requires us to evaluate all possible effects and how they would contribute to or detract from everyone’s happiness. ) Furthermore, in the case of voluntary euthanasia, traditional utilitarian justifications against killing do not apply.As Singer rightfully points out, the reason that randomly killing innocent people is morally wrong for a rule utilitarian is that people would suffer considerable anxiety from knowing that their life could be terminated at any point in time.
Euthanasia, however, is not an arbitrary action but one, which occurs only at the request of a suffering patient. Thus, no one would live in fear that their lives would be taken from them. Finally, to satisfactorily evaluate assisted suicide from a utilitarian perspective, one must consider the objection that perhaps a sudden cure for an individual’s illness could be discovered.That this possibility does indeed exist is not a viable reason for dismissing euthanasia.
Firstly, Mill acknowledges that we cannot always know with certainty the outcome of our actions, and thus we must instead look at the probability of each potential outcome. Medical science, today, is a detailed, painstaking process, which is not given to the discovery of unexpected cures. Specialists could reasonably know when a cure was in development and when a promising new drug would arrive on the market.That the cure for one particular person’s particular illness would be discovered within the few additional months, which he would have lived, is unlikely. Even if it were, this cure would probably not be available to him because it would have to undergo extensive testing by government regulators and because it probably would not work on an extremely advanced case.
Because the likelihood of a sudden cure is so low, we ought not adopt a rule requiring us to leave individuals suffering for needless days, weeks, or months.Their pain will far outweigh the pleasure of the handful of individuals who might benefit from such unexpected medicines. A final objection comes from the argument that utility is flawed as a theory. Life, opponents to euthanasia argue, has absolute and intrinsic worth and therefore it cannot be terminated in any circumstance or for any reason. Empirical evidence, however, suggests that we are unprepared for such an absolutist doctrine. Our society and all others acknowledge that certain values are higher than human life.
For instance, we execute prisoners who could likely be safely contained in prisons because we believe that achieving justice is more important than preserving human life. Women who are in danger of being raped and thus kill their assailant are immune from murder charges; we believe that protecting their rights to liberty and sexual inviolability takes precedence over another’s right to life. When the government sends soldiers to battle, it knows that at least some of them will die, and thus, it implicitly suggests that freedom and national security are more important than the soldiers’ lives.Even if we do not accept the forgoing argument, the deontological categorical imperative supports euthanasia by arguing that persons with absolute worth are due more than a life filled with agony.
If, as James Rachels envisions, “you were given the choice between dying quietly and without pain, at the age of eighty, from a fatal injection, or dying at the age of eighty plus a few days of an affliction so painful that for those few days before death you would be reduced to howling like a dog,” (Bonevac, 460) you probably would not universally will the latter choice.Furthermore, as Roger Sullivan explains “according to Kant, our moral reason recognizes in an objective and disinterested way that we are not only persons having intrinsic worth but also finite beings with needs to be met, and it insists on the strict right of all human beings not only to strive for but to attain that happiness to which their moral worth entitles them” (Sullivan, 220). The capacity to exercise our rationality and reason morally is what makes human existence meaningful.Individuals suffering from unbearable pain are still “persons” in the moral sense because they have the capacity to distinguish right from wrong, but in every other respect, they are deprived of the things that make their life desirable. They no longer have the ability to use their rationality and grow as individuals; instead, the entirety of their mental and physical processes is directed toward enduring their pain.
They have become mere animals struggling for survival and have thereby been stripped of their dignity.To force someone with intrinsic worth to continue in such condition treats him or her as less than human; in fact, it denies them the consideration that we would give an animal in a similar circumstance. Having examined the justifications for euthanasia as a principle, I will now proceed to examine whether there is a distinction between passive euthanasia (letting a patient die by not treating him, for instance, by removing feeding tubes) and active euthanasia (taking some action to cause the patient’s direct, immediate death, for instance, administering a lethal injection).James Rachels explained the AMA’s philosophy on mercy killing when he wrote, “[they believe] it is permissible, at least in some cases, to withhold treatment and allow a patient to die, but it is never acceptable to take any direct attain designed to kill a patient” (Rachels, 29). In the United States, as in most countries, passive euthanasia is legal while active euthanasia is not.
The basis of this thinking is that passive euthanasia involves only an omission, “letting the patient die,” while active euthanasia involves a direct act.By explaining that there is no morally relevant difference between acts and omissions, I will prove that active euthanasia is not immoral. For a utilitarian, that there is no distinction between acts and omissions is obvious. The consequences of our choices determine their morality; because the consequence of both passive and active euthanasia is death, the two acts are morally equal. Furthermore, from a utilitarian perspective, active euthanasia may be preferable to passive euthanasia.As Rachels explains, “if one simply withholds treatment, it may take the patient longer to die, and so he may suffer more than he would if direct action were taken and a lethal injection given” (Rachels, 30).
If we examined the case of Rachels’ hypothetical throat cancer patient, we would see that this is certainly true. Most likely, he is being fed intravenously, and it is the removal of this feeding tube that will allow him to die.Doing so means that instead of dying quickly, he will slowly starve to death, still suffering from the unmanageable pain even though a lethal injection could have ended his -- and his family’s suffering -- much more quickly. If the object of utilitarianism is truly to increase pleasure and decrease pain, passive euthanasia is clearly immoral.
For a deontologist, it is the intent of an action rather than its effect, which determines morality.According to Immanuel Kant, omissions are subject to the same moral rules as acts (this, in itself, tells us that there is no morally relevant difference between acts and omissions): they are morally acceptable only if we could will them to be universal laws of nature. We could not universally will that letting someone die is morally distinct from killing him or her. To see this, we need only consider the following scenario: Suppose that two friends, Wayne and Garth, get into an argument about a woman whom they both like.
Garth strikes Wayne, and the argument escalates to a brawl. It quickly becomes apparent to Garth that he will lose the fight, so he picks up a board and strikes Wayne over the head. Wayne falls to the ground, bleeding; he is unconscious and shows no sign of waking. At first, Garth is concerned; the injury appears to be much more serious than he intended.
Then it occurs to him that if Wayne were to die, he would have less competition for the woman’s attention.Though he does not directly assault Wayne again, he does not seek medical attention and, several hours later, watches as he dies. Neither we, a judge, nor a jury would be satisfied with Garth’s explanation that he only “allowed Wayne to die;” we know that Wayne could have been saved by a competent team of paramedics, and that Garth’s intention was that Wayne would die from his injury. Moreover, we certainly would not will as a universal law of nature that people are not morally culpable, when by their omission, a person who could have easily been saved dies.We can apply this logic to the case of active and passive euthanasia.
As Rachels tells us, “The AMA policy isolates the crucial issues very well; [it] is the ‘intentional termination of the life of one human being by another. ’ But after identifying this issue and forbidding ‘mercy killing,’ the statement goes on to say that the cessation of treatment is not the intentional termination of the right to life” (Rachels, 33). When a physician does not treat a patient, he does so knowing and intending that his patient will die.This is in no way different from administering a lethal injection with the knowledge and intent that it will cause a patient’s death. Finally, because morality implies legality to many, I will conclude with a brief discussion of the legality of active euthanasia.
The suffering of terminally ill patients is so great that to comprehensively ban assisted suicide would be a grievous error, but particularly since America’s health care is almost completely governed by for-profit HMOs, it is important to establish very stringent safeguards.The best way to protect patients from coercion by families eager for their inheritance or by insurance companies hoping to cut their costs is to allow euthanasia only to those who have previously requested it in a living will. Insurance companies could be legally prevented from raising premiums for those who do not desire euthanasia in the event of a terminal illness. Such a policy also answers a common objection to euthanasia--which people suffering from crippling pain are not rational enough to decide that they want to die.
