Monday, 4 October 2010

Euthanasia

Euthanasia

Few debates in modern ethical philosophy polarize sentiment so completely than the debate concerning Euthanasia. It is a subject, which stimulates wide-ranging and often emotive responses, more often than not from contrasting polemical positions, from which sound reasons and not so sound intuitions issue forth. What I will attempt to achieve in this essay is an informed debate on the contrasting positions of the distinction drawn between passive and active Euthanasia. I will also briefly touch upon other relevant issues, such as preconceptions of death, and some historic-religious background to the Euthanasia debate, in the hope that in charting a course through this minefield, we may come to understand more fully the argumentation surrounding this emotive issue.

It may be helpful initially to divide this anfractuous debate into constituent parts, so as not to confuse the varying issues. Although it will become apparent that all the issues to be addressed do in some degree or another dynamically touch each other. Firstly, however, I would like to define some essential terms so that no confusion arises from any interpretation in this matter.

For the rest of this essay, the term ‘passive Euthanasia’ will denote an act of omission, and the term ’active Euthanasia’ will denote an act of commission, in which the life of a person is cessated. It may well, however, become obvious that these distinctions blur somewhat upon finer analysis. The term ‘voluntary Euthanasia’ denotes a consensual act of the person, such that, the person for reasons pertaining to their death has granted verbal, written or some prior permission for Euthanasia to occur.

Euthanasia stems from the Greek, (eu=well or good, thanatos=death), it literally means to have a good death, as was perceived by the Greeks, dating back to at least the times of Zeno, and more likely beyond. For as long as men have fought wars the practice of alleviating the suffering of fallen comrades on the battlefields has been with us. It was a practice in common use, yet not advertised, during the first and second world wars of last century.

Diogenes Laertius says of Zeno’s death (1)“the sage leads himself rationally out of life, namely on behalf of fatherland or friends, also when he suffers from pain which is too fierce, mutilations or incurable diseases”. As we can see the Greeks had a healthy respect for the rights of the individual to take control of there own destiny in this matter, in fact, it was more of a duty, to take this matter into ones own hand so as to alleviate the vicarious suffering incurred by family and friends, and in some respects the wider community.

Hindus too, do not see death through the same eyes as it is perceived in the west. Death is a transition through which one passes into another incarnation, in a constant interplay of death and rebirth, the soul is what is of utmost importance, and thus the cessation of life is merely an illusion brought about by the perception of a carnal body within the temporal chimera of the dance of Vishnu. In fact the act of ‘suttee’ where the wife throws herself upon the funeral pyre of her dead husband was a form of honorable death and invested with great esteem in the Hindu culture. Although it must be said that this practice has now been outlawed due to its pervasive barbarity and denigration of the wife as chattel rather than a person in her own right.

Buddhists too have an altogether different conception of the body. One in which the cycle of samsara, (birth, death and rebirth) is constantly revisited until the soul evolves to a point from which it transcends the mundane world and evolves to a higher plain of existence. Death is a necessary gateway in this perpetual cycle of suffering. For, Buddhists believe that to inhabit the mundane world is to live each day in suffering. In fact, it is a central tenet of Buddhist philosophy that life is suffering, and death is ultimately the form of release from this worldly suffering.

In Japan also, the act of ‘hari kiri’ was a way the dishonored warrior or family member could reestablish the familial and personal honour that was of utmost importance to the society as a whole, thus suicide was a medium through which dignity and respect could be won rather than lost.
The reason I illustrate these few alternate cases is so that we may have a clearer conception of the debate in light of the context in which it exists. For it is for the most part a peculiarly western dilemma, one born from the womb of our Judaic-Christian heritage, and brought to it’s pinnacle in light of angst ridden atheistic existentialism that permeates modern culture. It may then be enlightening to glean from whence this enigmatic debate comes. The Hebrew tenet ‘Thou shalt not kill’ (2) is commonly believed to be the sixth commandment of the ten that were handed down to Moses on mount Sinai, during the exodus of the Hebrew nation from Egypt. It is a crucial point in the religious position of those that oppose any form of Euthanasia, especially active Euthanasia, that this covenant be adhered to. Yet under careful analysis, the Mitzvah, in exodus, actually translates as ‘thou shalt not murder’, murder here being translated from the Hebrew word (3)‘ratsach’. This may seem like hair splitting but in fact, it is absolutely crucial in any religious interpretation of the text and thus the question in hand. There is in fact no word in Hebrew for the term suicide, and consequently no negative connotation connected to the act of suicide. There are a number of recorded cases in the bible that mention suicide but it appears that no negative repercussions ensue from this action. This is evidenced by the story of Achitopel in the book of Samuel2, who after putting his house in order, hangs himself, and is buried in the family sepulcher, and thus does not appear to incur any societal censure given his ability to remain within the designate of his family.

Historically speaking, the first sustained attack upon the act of suicide within the Christian tradition is penned by saint Augustine (354-430 ad), in response to the unfortunate yet widespread practice of the day, in which Christians would either martyr themselves by riling an adversary so that they would be killed. Alternatively, kill themselves, in some other way, so as to ensure eternal salvation in the afterlife. This was done immediately or as soon as possible after baptism, in which the soul was purged and cleansed from sin, so that death would ensure that the subject did not sin again and thus confer eternal damnation. As one can imagine, this practice had a most deleterious effect upon the Christian population of the day, and it therefore fell upon Augustine to nip this practice in the bud. This he did through an appeal to the afore mentioned sixth commandment. Further appeals by Saint Thomas Anslem, were made during the years 1225-1274 ad, and these rested upon three alternate arguments found in his ’Summa Theologica’. Firstly, Anslem states that suicide contravenes the natural law of love and is thus sinful. Secondly, it was his assertion that due to the fact that no one exists in isolation the act of suicide was deleterious to the community as a whole. Last but not least, his third argument was grounded upon the premise that we are in fact creatures that belong to God, and thus it was by Gods divine providence alone that the matters of life and death should be settled, and not by the hand of man. I do not wish to enter into the theological debate on these issues, but rather it is my intention to sketch, albeit briefly, the historical background from which modern religious opponents of Euthanasia draw there argumentation, so that the arguments may be illuminated in light of the historical context from which they derive. It is pertinent to point out though, that the afore mentioned reasoning, if taken to its conclusion would rule out all forms of selfless heroism, in which one may sacrifice oneself in order to save one or a multitude of others. This very same selfless heroism is at the core of Christianity, and can be seen in Christ’s foreknowledge of his impending death at the hands of the Romans, in the garden of Gethsemane. Rather than flee, he meekly surrenders his freedom in the knowledge of what is about to befall him, hence he sacrifices himself willingly so as to ensure universal and eternal salvation for humanity. This is in fact, the very same act of selfless heroism against which Anslem protests and a clearer or greater example, I contest, can not be found. In fact, I would contend, it is the very fact that Christ acts in this selfless manner in full knowledge of his actions and the precedent repercussions, that has attracted so many adherents to the Christian faith. So, far from being the case, that heroic acts of self sacrifice are an abomination to God, if we are to believe the Christian position that Christ is the son of God and thus one with God, it would seem logically consistent to infer that such acts are in some way divine and thus cannot be in any way abominable.

Leaving aside the various religious arguments for now, I would like to pursue a more contemporary debate, although it will become clear that many of the specious arguments propounded by anti-Euthanasia proponents owe much to these antecedent Christian positions for there moral import.

Much of the contemporary debate surrounds the competing notions of passive verses active Euthanasia, where it will be remembered that we have defined these two terms as both omission and commission respectively. The lay view has seen these differing conceptions as a debate between letting a person die and actively killing them, where the first is generally considered to be morally acceptable and the second, that of actively killing them, as morally repugnant. As we will soon see though these preconceptions are somewhat arbitrary and can for the most part be misleading. Let us now look at some practical situations, to illustrate the point. It may well be the case that in a situation in which a person has been involved in a serious motor vehicle accident, where upon arrival at the hospital and subsequent to further medical care, the prognosis for the patient is far from favorable. Let us say that this person is exhibiting abnormal brain wave activity issuing from the ophthalmic region, which is often critical in deducing brain death. Further more, they can only continue to survive if they remain connected to artificial respiration and the like. In such cases, we would be likely to say that in turning off the artificial life support systems, we were leaving to providence the persons natural ability to survive, and thus this would clearly be a case of letting a person die. It must be said, at this juncture, that various issues such as futility, informed consent, and financial and resource pressure have been left aside for now in this rather simplistic example. Imagine if you will a case in which this same person arrives at the hospital and after extensive medical treatment regains consciousness in full grasp of their faculties. Unfortunately they have been left so traumatized by there injuries that they will never have feeling below the neck again, and there head and scalp have been so badly burnt that they are in prolonged and extensive pain that is barely imaginable. In this case, the person may continuously beg to be put out of the psychological and physiological pain from which they cannot escape. The torment for this person is beyond the bounds of superhuman suffering, and the only way this person can escape this horror, for horror is what it would be, is to have some assistance to end their plight. If, as a grief stricken relative or caring medical practitioner, you were to assist this person in their wishes you would be actively killing this person, due to their inability to action their wishes without assistance, and here in lies the difference. The moral worth assigned to both actions, as we have already mentioned, has usually been predetermined, yet it becomes at once clear that in cases, such as these, the moral designation afforded to active and passive Euthanasia becomes somewhat blurred, if not totally arbitrary. It may well be far more reprehensible to insist the second person suffer their existence because of our predetermined moral principles, than to insist upon the continuance of the unconscious first person, maintained under artificial means, and visa versa in ending there respective struggles. What may be critical here is the notion of quality of consciousness. Part of what we have believed, in the west, as the sanctity of life has been inextricably tied to the notion of the sanctity of consciousness. For many, consciousness is a blessing, a divine gift, a heaven in the here and now, Yet this very same consciousness may to some, and indeed I contend, is, a living hell; from which there is no escape. Those that insist that they suffer this hell, are merely the devil’s tormentors. The cyanide capsule given to spies and French resistance fighters during the second world war, was not only given to them to protect the others in the cells in which they operated, but rather was seen as a humane alternative to the grotesque forms of torture that the Gestapo would use to extract information from those unfortunate enough to be captured. The question must then be asked why in times of peace do we not afford the same dignified exit from existence that was afforded those born in a time of conflict and war?

James Rachels makes some very telling points in his influential paper ‘Active and passive Euthanasia’ (4). Rachels asks us to imagine a situation, all too real, in which a patient in hospital is dying of incurable throat cancer. The doctors agree that the situation is hopeless and thus agree to the patient’s pleas to forgo further treatment, as it would only prolong his agony. Now, once this decision has been made to forgo further treatment, it may well be the case that active Euthanasia is preferable to passive. Given the fact that under a regime of passive Euthanasia the patient will take longer to die and hence suffer longer than if the doctor administered a lethal dose of some narcotic. The point being, that if the object of Euthanasia is to alleviate suffering, (and some would say this is the only reason for it), then active Euthanasia may indeed be more preferable to just letting the person die, as this passivity may indeed take longer and cause extended suffering, which is exactly the situation one is trying to avoid.

Rachels second argument is that cases decided upon the conventional doctrines as purported by the AMA (American Medical Association), lead to decisions of life and death made upon irrelevant grounds. The AMA’s stance on such matters as active and passive Euthanasia can be succinctly put by way of reference to a statement expressed to the House of Delegates of the AMA on Dec 4,1973: (5)
‘The intentional termination of the life of one human being by another-mercy killing-is contrary to that for which the medical profession stands and is contrary to the policy of the American Medical Association. The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is imminent is the decision of the patient and/or his immediate family. The advice and judgment of the physician should be freely available to the patient and/or his immediate family.’

Rachels asks us to consider a case where a Downs syndrome baby is born into the world with a congenital intestinal blockage. If the baby receives an operation to clear the blockage, the baby will live, but if the parents do not consent to the operation then the baby is doomed to die. The point being that, the decision to operate or not, is being made upon the basis that the baby has Downs Syndrome, not upon the basis of the intestinal blockage. The parents and specialists then have made a value judgment that due to the Downs Syndrome it would be better for the baby to die. This being the case, the decision of life and death is being made upon irrelevant grounds, here being the intestinal blockage. The idea here being that those babies with the intestinal blockage are allowed to die, where as those without the blockage are not, given the fact that the doctrine forbids active intervention in the death of the baby. This is counter intuitive as a form of reasoning given that the motivating reason behind the ‘letting the baby die’ is not the blockage but the Downs Syndrome. I do not wish here to debate the various merits of the differing appeals to whether Downs Syndrome babies have lives that are worth living. For this is a minefield in itself, and brings to mind the ‘wedge’ arguments propounded by pro life adherents who point to the Euthanasia laws of the Nazi’s, and there infamous ‘lives that aren’t worth living’ statements, that acted as dubious justification for the eradication of the aged, sick, infirmed, mentally retarded, Jews, Gypsies, and eventually all non Germans. Rather the point is made to illustrate the internal inconsistency in the AMA’s statement and to show that often decisions of life and death are made upon irrelevant grounds.

A further argument is made by Rachels concerning the moral arbitrariness of the distinction between letting some one die and actively killing them. Here Rachels makes a clever distinction by way of analogy. He asks us to consider a situation in which ‘smith’ is out to kill his young cousin, so as to secure a large inheritance. ‘Smith’ waits for the boy to take a bath and wanders into the bathroom with the full intent to murder him. This he does by drowning the poor boy, and then makes things look as though an accident has occurred. He then asks us to envisage the same situation for a man called ‘Jones’. ‘Jones enters the bathroom with the same malefic intent. Unlike the ‘Smith’ situation however, upon entering the bathroom, ‘Jones’ sees the boy slip over and fall into the bath in which he quickly drowns. ‘Jones’ does nothing to help the boy as he drowns. The point being that the same intent to cause harm to the boy is present in both situations and thus both are equally morally deplorable. Yet, in the ‘smith’ case, the death is actively brought about, and in the ‘Jones’ case, the death of the boy is realized by an omission on the part of ‘Jones’ to help. Are we then to say that ‘Jones’ passivity is morally better than ‘Smiths’ activity? I think not. For both are as morally corrupt as each other, and thus the distinction between active and passive falls away under the predilection of original intent. It is the underlying moral culpability, and not the actions or inaction’s of the perpetrators that Rachels is thinking of in connection to the AMA’s directive concerning the difference between passive and active Euthanasia.
Rachels states: (6)
‘The bare difference between killing and letting die does not, in itself, make a moral difference. If a Doctor lets a patient die, for humane reasons, he is in the same moral position as if he had given the patient a lethal injection for humane reasons.’
On the face of it, this appears to be a powerful argument for those who contend that the distinctions between active and passive Euthanasia are morally arbitrary. Let us then look at this proposition more closely. In order to do this I will lean rather heavily upon the observations of Tom Beauchamp in his critical reply to Rachels entitled ‘A reply to Rachels on active and passive Euthanasia’ (7).
Beauchamp rightly concedes that Rachels is correct in assuming that the passive /active distinction is sometimes morally irrelevant, but contends that the above case is so dis-analogous to the cases envisaged by the AMA that it fails in its assertion, that distinctions between killing and letting die are always morally irrelevant.

The first problem with the Rachels analogy is the fact that it is an analogy. Analogous arguments suffer from the failing that they usually only hold for relevantly similar cases, and thus it weakens the Rachels assertion that from this particular case we may draw wide ranging and sweeping conclusions about the passive/active debate in toto.

Secondly it is rightly pointed out by Beauchamp, that Rachels cases, involve two unjustified actions; unjustified due to there original intent, which makes them morally reprehensible. The AMA, however, distinguishes between justified cases of letting die and unjustified cases in which active means are used to terminate life. We shall revisit this distinction soon, for it is this distinction, concerning just such justification, which is at the heart of the passive/ active debate.

Thirdly, In Rachels example, both Jones and Smith, are morally responsible for the death of the boy, and us thus equally morally culpable. The AMA however designates an agent morally responsible only if they actively take a life; but the same agent is not morally required to preserve life, (in extraordinary situations), and is thus not held morally responsible for the patients death, when removing the patient from the extraordinary means of life support. What one denotes as extraordinary is itself the subject of considerable debate. A debate I do not wish to pursue in any great length here. For reasons of brevity, We shall take extraordinary to mean, any procedure that is both artificial, beyond societal normalcy, and at the cutting edge of modern medical technology. Although it must be mentioned that, what one perceives as artificial and extraordinary will vary in an inverse manner to ones exposure to the technique and its consequent availability. Remembering of course that Antibiotics where considered extraordinary not so long ago, but are today commonplace.

All these refutations point to the fact that, Rachels conclusion, that passive/active distinctions are always morally irrelevant, rests upon shaky foundations.
At this juncture Beauchamp brings to the table the often-cited case of Karen Ann Quinlan. In 1975, Karen Ann Quinlan stopped breathing for several minutes, for reasons unknown to this day. She received mouth to mouth resuscitation, which failed to revive her. She was then rushed to a New Jersey Hospital, in which she was attached to life support mechanisms, which supported her. Physicians pronounced that she was in a chronic, persistent vegetative state, and her father appealed to the court for legal guardianship, with the express purpose of taking her off life support. After much legal wrangling, in which the debate ranged between physicians that believed her to be beyond rehabilitation and those that were not so convinced. The New Jersey Supreme Court upheld the Fathers appeal and allowed him guardianship, at which juncture the life support mechanisms were turned off. Karen Ann Quinlan survived until 1985 when she finally passed away, never recovering from the coma she had fallen into ten years previously. This, as Beauchamp rightly notes, is much closer to the kind of case that the AMA had in mind in it’s directive concerning passive Euthanasia. Beauchamp asks us to envisage a situation in which, the father of Karen Quinlan benevolently wishes the doctors to administer his daughter with an overdose of morphine, thus terminating her life painlessly. We would be tempted, he believes, to say that the initial situation is morally justified, and the second, in which the doctors actively terminate Karen’s life, is not. What then is the distinction he is drawing upon here? It rests in our judgements of medical fallibility and moral responsibility. After all there is the remote possibility that the medical profession might be wrong in there prognosis, as has been evidenced in other cases in which comatose patients have miraculously revived to lead healthy happy lives. To bring about her death then would be to ‘preempt the possibility of life’ (8), where as to allow her to die by the removal of artificial equipment removes the moral responsibility that comes with wrongful diagnosis and medical fallibility and thus absolves one from moral responsibility in the taking of a life under circumstances of wrongful diagnosis. The distinction here is that active termination of life removes all possibility of life for the patient where as passive means may not.

The major point is that due to differing moral principles that can govern similar situations we may sometimes be morally culpable for actively killing someone, but not so, when we allow them to die. The problem is, that there will be cases in which we are morally culpable for the death of an individual under both the active and passive distinctions; and conversely, morally justified in taking a life in other such cases. Circumstances in which we may be morally justified in taking the life of some one else, in an active manner, can be seen in such real life scenarios as self-defense, or within a wartime framework, where one fights for some other competing right. The distinction between active and passive and the consequent moral culpability then is somewhat dependent upon the circumstances in which that decision is to be made. A judgement to ‘allow to die’ is just as likely, and in fact, is almost wholly dependent upon knowledge that is possibly fallible, as is the judgement to kill. Obviously, this fallibility is quantitatively and qualitatively dependent upon who is giving the assessment in each specific situation. For the most part Medical practitioners who specialize in various fields would be far more likely to give an increasingly closer approximation to the potential prognosis for patients coming under there specialized fields, than would the lay person, and for the most part this is why greater weight is given to their expertise in these matters. It must be cautioned though at this point that even specialists can be wrong, for they are only human after all, and often rely upon laboratory results for there informed opinions. To return to the point Beauchamp is making though, if we kill the patient then we are certainly culpable for their death, but in similar vain, if we cease treatment, and the patient dies, where had we continued with the treatment the patient would have lived, we may equally be responsible, and thus morally culpable. The assertion made by Rachels, that passive/active distinctions are always morally irrelevant then, fails under the auspices of responsibility, and the best we can say is that sometimes the passive/active distinction is morally arbitrary.

Beauchamp then goes on to offer an alternative argument that rests upon the doctrine of rule utilitarianism, and although eloquently argued, it suffers from the same complaints that other forms of utilitarianism suffer, for this and many other reasons, I do not use it here.
Another often cited species of argumentation made by proponents who oppose voluntary active Euthanasia (VAE), but may or may not support passive Euthanasia, is the ‘slippery slope’ or ‘thin end of the wedge’ species of argumentation. This form of argument would have little philosophic import; if it were not for the fact, that the fears expressed by proponents of such arguments had not already been realized during the Nazi regime in Germany in the 1930’s and 40’s. The subtlety with which this pernicious abuse occurred must give any proponent of Euthanasia, either adherents to passive or active, cause for concern. I cannot for this reason dismiss out of hand the concerns voiced by those that fear the types of abuse that can occur under a legitimized and legalized regime of Euthanasia, and for this reason alone, a closer inspection of those very concerns must be addressed in any legitimate discussion of Euthanasia laws.

In 1920, a book entitled ‘The permission to destroy life unworthy of life’ by Alfred Hoche .M.D, and Karl Binding was published. It had an immediate effect upon the German psyche. It argued that under very specific situations, a patient should be able to ask for ‘death assistance’. The patient had the right at any time to ask for their request to be withdrawn and a panel of three competent professionals was to decide upon this request. It was explained that the ‘death assistance’ was highly congruent with the highest medical ethics, and was essentially a compassionate solution to a painful situation. The book explains further how this ‘death assistance’ was not to be limited to just those patients who asked for it, but was to be offered to ‘empty shells of human beings’, thus allowing valuable resources to be channeled to patients more deserving of proper treatment. Already parallel’s can be drawn between some of the arguments propounded by modern Euthanasia supporters and the sentiments expressed in this book.
During the 20’s and early 30’s, various articles, films, and documentaries were created that rejoined the sentiments expressed in this book. In 1933 an article appeared in the NY times (10/8/33, page1 column 2) that reported the then German justice minister as saying ”it would now be possible for physicians to end the tortures of incurable patients, upon request, in the interests of true humanity, and the savings would redound to the German people, if money was no longer thrown away on the disabled, the incurable, and those on the threshold of old age”.
The scene was now set for further slippage down the road towards eventual genocidal carnage, for the seeds of just such a result had been sown in these early years. The ‘Baby Knauer’ case occurred in 1938, and is celebrated, if celebrated is the right word, as a turning point in the general acceptance by the German population of an active Euthanasia program. The father of ‘baby Knauer’ appealed directly to Adolph Hitler, to allow his son to be allowed death, as the child was blind, retarded, and missing an arm and a leg. Hitler turned the case over to his personal physician, Karl Brandt, and the request was granted. What followed was the incremental and gradual erosion of any semblance of civilized humanity. A committee was established to adjudicate upon ‘mercy killings’. ‘Hungerhauser’ were established to starve and in some cases freeze the aged and infirmed. Eventually this would result in the work camps in which millions of 'non-humans', or Jews, were systematically murdered.

It is important to note that during this time, no laws were passed concerning Euthanasia, merely edicts from the Fuhrer, for by the time the ‘hungerhauser’ were established in 1941 Euthanasia had become just normal hospital routine.

Although this is an analogous argument, and we have already stated, analogous arguments suffer from the failing that they are only useful when applied to relevantly similar cases, parallels may still be drawn and lessons learnt from the subtle and incremental way in which this horrific systematic barbarity crept upon the generally normal population that inhabited Germany in the 20’s and 30’s.

Arguments of this sort are indeed intuitively horrifying, and so they should be, for it is just such abuses that we should be constantly and zealously on guard concerning. Parallels can be drawn between the circumstances that surrounded the debate of the 20’s and 30’s in Germany and those of the modern era, it would however, be over reaching the point to insist that even with the proper safe guards in place, humanity will slide inevitably towards such abuses. A warning however must be taken in light of this historical evidence. That is, in any well-meaning program, from which potential exists for abuse, safeguards must be sufficiently stringent to obviate the potential for such abuses. Under a system of Democracy, the potential certainly exists for well meaning programs, such as consensual Euthanasia laws, to fall foul of the warnings of these past atrocities. It would not be beyond the realms of possibility for instance for beneficent and well meaning laws to be passed that under the current administration find no corner for abuse, yet ten or twenty years hence are twisted to meet the demands of those with hidden agendas and more malefic intent. Already this millenia we have witnessed in the United States of America the rise of a new order within the Republican party, who have had potentially terrifying and callous policies, that would make the Nazi party policies pale in comparison. Can we be sure that laws passed today are universally and temporally respected for the intent in which they found inception? The answer to this question is undoubtedly an unqualified ‘do not know’. Thus, it is undoubtedly important to bare this in mind whenever we formulate laws that on the face of it conform to our principled beliefs. Laws after all are not temporally specific, as we are; they cross the bridge of time and consequently effect future generations in ways that we may never be able to envisage.

Does this mean then that we must reject any form of Euthanasia on the grounds that it may, or may not be abused? Certainly, we have seen evidence in this essay of the compelling nature of many of the arguments both for and against passive and active Euthanasia. Yet, we have by no means exhausted the potential positions of both sides of this debate. Further research into this issue would entail a detailed exploration of voluntary Vs involuntary Euthanasia and such subsequent Arguments the like of which I can briefly outline here. Those in favor active Euthanasia point to assertions that:
1)Individuals have the right to decide about there own lives and deaths.
2)Denying terminally ill patients the right to die with dignity is unfair and cruel.
3)People have the right to die with dignity and lucidity.
4)Autonomy trumps all.
Whilst some of the issues that are propounded by those that oppose a policy of (VAE) are:
1)Can we be sure that consent is voluntary?
2)Allowing active Euthanasia will lead to abuses.
3)What of the possibility of mistake.
4)Can the taking of human life ever be morally acceptable outside of special circumstances like war, and self defense.
5)Does it not run counter to the Hippocratic oath to insist that Medical Practitioners perform active Euthanasia?

The point here is that this is a highly anfractuous and contorted issue and one in which the full range of human emotions range. I have been confronted with the reality of the intellectual debate as it exists today, through the contraction of terminal cancer and eventual death of my step father, and have experienced first hand the effects this had upon not only the person who contracted the terminal illness, but also the subsequent effects on those who both loved and cherished this person. Without a doubt, the issue of suffering was at that time central to my concerns, and formally held intuitions were radically challenged in the face of the reality that came with such a diagnosis.

As I started this essay so shall I finish it, with the observation that western conceptions of Death may in themselves be inextricably tied to misconceptions wrought by a sanctified predilection towards death as an evil, rather than as a release from suffering and a transcendent passage to a better place. For anywhere may be better than here, when the pain and suffering of existence so clouds the mind that the quality of ones existence falls below the threshold for which only the sufferer can adjudge.

As to whether we can legislate upon this suffering I am at present undecided, and as with any anfractuous and problematic conundrum which may have far ranging repercussions, I can only say that at this juncture it may well be that we must err on the side of caution, for to construct a society that seeks to rid itself of the meta-moral that life is sacrosanct, is to walk a dangerous line, that has historical precedent in some of our most heinous evils as a collective humanity.

Bibliography.
1)Stoffell, Brian: ’voluntary Euthanasia, suicide, and physician-assisted suicide’ in ‘A companion to bioethics’
Ed by Kuhse, Helga and Singer, Peter.
(Blackwell, 1998:pp272-279)
2)Grassian, Victor: ‘Moral Reasoning’.
(prentice hall publishing, 1981)
3)Chan, Wing-Tsit: ‘Chinese Philosophy’.
(Princeton University press, 1963)
4)Rachels, James: ‘Active and passive Euthanasia’.
In the ‘New England Journal of Medicine’vol292, pp78-80.
5) Beauchamp, Tom L: ‘A reply to Rachels on active and passive Euthanasia’. In ‘Social Ethics’ Ed by Mappes, T, and Zembaty,J: (NY, McGraw Hill, 1976).
6) Kubler-Ross, Elizabeth: ‘On Death and dying’.
(NY, Macmillan, 1974).
7)Singer, Peter: ‘The legalisation of voluntary Euthanasia in the Northern Territory'’
in ‘Bioethics’, volume 9, number5, 1995,
8) Pence, Greg: ‘Dr Kevorkian and the struggle for physician-assisted dying’.
In ;Bioethics’,vol 9, number 1, 1995.
9) Beauchamp,Tom L, and Walters, Leroy; ‘Contemporary Issues in Bioethics’, (3rd ed, Wadsworth, 1989).
10) Beauchamp, Tom l, and Childress, James F; ‘Principles of Biomedical ethics’ , (4th edn, Oxford university press, 1994).
11) Callahan, Daniel; ‘Pursuing a peaceful death’.
(Hastings center report, July-August, 1993,pp33-38).
12) Schneiderman, Lawrence j, and Jecker, Nancy s, and Jonsen Albert R; ‘Medical futility: It’s meaning and ethical implications’.
In Annuls of internal medicine , volume 112, number 12, June 15, 1990.





Endnotes.
1.Page 272 of bibliography reference(1)
2.Page 273 of ibid.
3.Page 273 of ibid.
4.Reference article in bibliography (4)
5.Page 312 of ibid.
6.Page 315 of ibid.
7.Reference article in bibliography (5)
8.Page 321 of ibid.


 © Richard Michael Parker 2000


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