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2.3: Euthanasia, or Mercy Killing (Nathan Nobis)

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9 Euthanasia, or Mercy Killing Nathan Nobis 24

1. Introduction

Sadly, there are people in very bad medical conditions who want to die. They are in pain, they are suffering, and they no longer find their quality of life to be at an acceptable level anymore. Given all that, they want their lives to end: they want to be out of their misery. Some of these people are kept alive by machines or other medical treatments. If these machines were turned off or the medical interventions stopped, these people would die.

Can it be morally permissible , or not wrong , to turn off these machines or stop treatment and so let someone die, in circumstances like these? Many people think it can be. They believe that, morally, we do not have to do everything we can to keep someone alive, no matter their quality of life or what they want. Indeed, sometimes keeping someone alive, when they could be allowed to die, would be wrong: we really should just let them die.

Here I develop an argument for this view, that what’s usually called “passive euthanasia” can be morally permissible. More interestingly though, I explain how the reasons in favor of passive euthanasia suggest and support thinking that in some circumstances “active euthanasia” is justified, so it can be OK to actively kill some patients, for example, by giving them an overdose of drugs that will painlessly end their lives. So, I argue that if you think it can sometimes be OK and appropriate to let some patients die, then you should also think it can sometimes be OK and appropriate to actively kill some patients.

2. Definitions

Let’s begin with some definitions to better understand the issues.

First, our topic is euthanasia , which is sometimes called “mercy killing.” The word euthanasia relates to the idea of a “good death.” People typically seek euthanasia to avoid a very bad death full of agony, pain, and suffering and all that results from that: for example, people wracked with horrific pain might not be able to meaningfully experience their final days or weeks with loved ones, due to the constant agony: when you are in terrible pain, it’s hard to talk, and listen, and share.

The most common type of euthanasia involves someone euthanizing someone else. Another type involves someone performing euthanasia on themselves, or euthanizing themselves: this is a type of suicide.

Euthanasia is usually classified as three types: voluntary , non-voluntary and involuntary :

Here we will only discuss arguments about voluntary euthanasia, but readers can thoughtfully extend that discussion to the unique circumstances of non-voluntary euthanasia. Since involuntary euthanasia, passive or active, is generally wrong, it won’t be discussed further.

3. An Argument for Passive Euthanasia

‘No’ suggests that we must always do everything we can to keep someone alive, even if they are miserable, want to die, and say so. To many, that’s just cruel. If a dog or cat were in a similar condition, we would do the merciful and humane thing and put them out of their misery: this is perhaps the one way that animals are often treated better than humans.

The judgment that ‘yes, it can be OK to let someone die’ can be supported by both consequentialist (or utilitarian) and Kant-inspired moral reasoning. What Kant himself argued about these issues might be different from what’s argued here: Kant sometimes applied his own moral principles to practical issues in unconvincing ways.

For the consequentialist, the person being out of their misery is a better consequence for them, and overall, than their staying alive: killing them decreases the net unhappiness, pain, and badness in the world. For the Kantian, letting them die respects their autonomy (or personal self-governance): we should respect people’s decisions about profound issues in their own lives. Given their reasonable desires, respecting their wishes treats them as “end in themselves,” but forcing them to live in their unwanted condition treats them as a “mere means” toward our own ends, not their own.

‘Yes’ can also be supported by spelling out conditions in which it can be OK to let someone die. We begin with an ‘if’ and develop a moral principle:

If …

• someone is dying, and
• is in horrible pain and suffering, and
• that pain and suffering cannot be relieved, and
• that person wants to die and clearly says so, and
• informed, thoughtful and caring people agree that the person would be better off no longer living…,

then it can be permissible to let that person die.

To many people, a principle like this seems plausible. And it justifies passive euthanasia in many circumstances.

The details of a principle like this, however, take us to harder questions about euthanasia, harder than those that arise in most circumstances: for examples, what if someone wants to die now but isn’t currently in horrible pain and suffering, or is expecting to die, but many years later after a very slow decline? Should anyone else have “say” over your own life or judge whether some pain and suffering is “horrible enough” for you to reasonably wish to die? If so, who? What if someone isn’t dying and doesn’t even have a bad medical condition but just finds their life not worth living and so wants to die (and so, say, plans to starve themselves to death or do other things that will result in their death)? These harder questions, and others, would need to be addressed for a complete defense of this or similar principles and any arguments based on them.

In sum, a basic case for passive euthanasia can be supported by utilitarian, Kantian and common-sense moral thinking. Let’s consider two objections before moving on to the case for active euthanasia.

3.1. First, some claim that pain can always be controlled, and patients always kept comfortable, so there is never a need to let anyone die (or, of course, actively kill them).

In reply, medical professionals try their best to control pain and make patients comfortable and they often are effective. But the insistence that pain can always be made bearable for everyone is, unfortunately, not true: some patients’ pains cannot be controlled to their own satisfaction.

3.2. Second, some argue that “miracles” are always possible, so there’s always a chance that someone gets better and even survives, and so we shouldn’t let patients die.

These hopes are understandable, but there are conditions that nobody has ever recovered from, and so the chances are very slim. And we don’t usually make important decisions based on very unlikely chances: for example, you could be in an unlikely car accident where a seatbelt harms you, rather than helps you: nevertheless, wearing a seatbelt is the smart choice.

Also, no type of euthanasia, passive or active, would prevent a miracle, especially a genuine miracle involving divine intervention: turning off the machines could be the occasion for a miraculous recovery, and an overdose of painkillers could be miraculously transformed into life-saving medications. People hoping for a miracle shouldn’t forget what miracles really could be.

4. An Argument for Active Euthanasia

The basic argument for active euthanasia, that is, for intentionally killing people who, due to their medical conditions, wish to be killed and say so is fairly simple.

We begin by reflecting on the basic reasons why passive euthanasia can be OK: it gets people out their misery and respects what they want for their own lives. “Letting people die” is a means toward those ends or goals. However, these goals can be pursued more directly and immediately by actively killing patients who wish to die. Letting people die often takes a long time, and that time will often be filled with pain and suffering, which the patient wants to avoid. Killing people, when they want to be killed , achieves the goals that they want, that is, to be out of their misery, more quickly and with less pain. And that is what they want, so they get what they want, quicker.

So, the basic assumptions that less unwanted pain and suffering is typically better than more and people’s desires about profound matters affecting their own lives and deaths usually should be fulfilled sooner than later , and the fact that killing someone is often a more effective means towards those ends, justifies active euthanasia, at least in some circumstances.

5. Objections: Potentially Relevant Differences Between Active and Passive Euthanasia

There are many objections to this type of reasoning, all intended to explain why active euthanasia is wrong but passive euthanasia can be permissible. Let’s consider some of the most common.

5.1. First, some claim that it’s always wrong to intentionally kill someone, so passive euthanasia can be OK but active euthanasia is wrong.

In reply, while we should agree that it’s, at least, nearly always wrong to intentionally kill someone, we should observe that most people want to live and do not currently have lives full of pain, suffering, and misery. So, the rule against killing is good in general, but we can argue that there are justifiable exceptions to this rule and that euthanasia is one of them.

5.2. Second, some argue that allowing active euthanasia puts us on a “slippery slope” to murdering patients, and people in general, who are not in challenging medical circumstances or do not want to die. That’s wrong, so we shouldn’t allow euthanasia, which might lead to that.

In reply, we can rightly wonder why that would happen, since arguments for euthanasia are very specific on the conditions where it might be permissible. They are especially clear that if someone wants to live, they should not be euthanized.

5.3. Third, some argue there is always an important (moral) difference between “allowing” something to happen and “doing” something, and so passive euthanasia is OK but active is not.

We might wonder if there is a clear distinction here. Consider this example:

You see that someone is about to unknowingly walk and fall into a deep pit in the ground. You could easily warn them of the pit, but you keep quiet and they fall in and are seriously injured. You tell yourself that if you had pushed them into the pit, you’d be blameworthy, but since you have “done nothing” you are completely blameless.

Many would find this judgment unbelievable: you did do something: what you did was stay silent and not warn them of the pit. “Inaction” is itself an action: doing nothing is doing something . Furthermore, what you did (in “doing nothing”) was wrong. It would often be worse for you to push the person into the pit yourself (or maybe not?), but your letting them fall in was wrong: you partially caused their injury: had you acted differently, they wouldn’t have gotten hurt.

Examples like these suggest that there are not clear moral or conceptual differences between doing something and allowing something to happen . The objection above mistakenly assumes there are.

5.4. There’s an important (moral) difference between killing and letting die, and so passive euthanasia is OK but active is not.

This final objection is similar to the previous. James Rachels famously responds with an example like this:

An evil aunt will inherit lots of money if her five-year-old nephew dies. She plans to drown him in the bathtub and make it look like an accident. She will get away with it. He just started his bath and she’s on her way to the bathroom to drown him. She opens the bathroom door and is delighted to see that he has slipped in the bathtub and is drowning. She watches, ready to push him under if he steadies himself and is able to save his own life. But, as her luck would have it, he doesn’t and so he drowns. She never touches him throughout the ordeal and inherits the cash, never telling a soul what happened.

What an awful story. What an awful aunt. Her motives were awful and what she did was wrong. If she explained that she didn’t “do anything,” that she didn’t do anything wrong, that, at best, she merely “let someone die” – it’s not like she killed anyone! – she is profoundly mistaken: letting someone die can be just as bad (or nearly as bad) as killing someone. We might even say that a way to kill someone is to let them die.

The objection here depends on a clear moral distinction between killing and letting die. There is no such distinction.

5.5. Mistakes are possible, so we shouldn’t allow euthanasia.

A final objection is not to the ethics of euthanasia per se, but whether, as a social or legal policy, it should be allowed: it’s possible that we could think an action is, or can be, morally permissible, but that for various reasons, as society we shouldn’t allow it.

The concern is that where active euthanasia is allowed, some people who should not be killed could be killed. This is true: this is a possibility. It’s also true that where passive euthanasia is allowed, some people could be let die who should be kept alive. The argument is that since mistakes and wrongdoing regarding euthanasia are always possible, we should not allow it as a society. (This is consistent with thinking that euthanasia is sometimes morally permissible).

In reply, we cannot ignore the opposing truth that if euthanasia is not allowed, that would result in mistakes and wrongdoing also: people would be wrongly kept alive, and wrongly forced to endure more suffering than they can bear and their deepest desires for their own lives disrespected.

These possible mistakes, unlike the possible mistakes in allowing euthanasia, however, cannot be corrected or addressed by any safeguards or precautions, if euthanasia is not allowed. The wisest strategy then is to allow euthanasia, with limits and safeguards, and work to ensure that any mistakes and wrongdoing are minimized, and hopefully prevented completely.

6. Conclusions

There are, of course, more objections to these arguments, and other important arguments and concerns to discuss, and factual information to review, to have genuinely responsible views about these matters: this essay is just a start.

These issues of this essay are important and not just for people currently facing difficulties where euthanasia might be part of the response. These issues are important to all of us since we have no idea what will happen to us, and our loved ones, years down the road, tomorrow, or even later today: an accident or illness might befall us that forces us to ask and answer hard questions about whether our lives are still worth living. While we hope these questions aren’t forced on us, we should ask them now and work on answering them now, together and as individuals. Part of a good death is that it is an end of a good life, and an opportunity to begin a better life is always now.

James Rachels, “Active and Passive Euthanasia,” New England Journal of Medicine 1975; 292: 78-80.

For Further Reading

Young, Robert, “Voluntary Euthanasia”, The Stanford Encyclopedia of Philosophy (Spring 2019 Edition), Edward N. Zalta (ed.), forthcoming URL = < https://plato.stanford.edu/archives/spr2019/entries/euthanasia-voluntary/ >.

Cholbi, Michael, “Suicide”, The Stanford Encyclopedia of Philosophy (Fall 2017 Edition), Edward N. Zalta (ed.), URL = < https://plato.stanford.edu/archives/fall2017/entries/suicide/ >.

Woollard, Fiona and Howard-Snyder, Frances, “Doing vs. Allowing Harm”, The Stanford Encyclopedia of Philosophy (Winter 2016 Edition), Edward N. Zalta (ed.), URL = < https://plato.stanford.edu/archives/win2016/entries/doing-allowing/ >.

For Review and Discussion

1. What are the reasons someone might their life to end? Are those reasons strong enough to support their ending their life? Why or why not?

2. We regularly euthanize non-human animals, but euthanizing people is limited to certain countries (most notably The Netherlands). Is there a major difference between non-human animals and people that justifies our different use of euthanasia? Why or why not?

3. What is the strongest argument opposed to allowing active euthanasia? Is this argument stronger than the arguments in favor of active euthanasia? Why or why not?

Euthanasia - Essay Samples And Topic Ideas For Free

Euthanasia, also known as assisted dying or mercy killing, remains a deeply contested ethical and legal issue. Essays could delve into the various forms of euthanasia, such as voluntary, non-voluntary, and involuntary euthanasia, discussing the moral and legal implications of each. The discourse might extend to the examination of the cultural, religious, and societal attitudes towards euthanasia, exploring how different societies and religious groups perceive the right to die. Discussions could also focus on the experiences of countries and regions that have legalized euthanasia, examining the impact on healthcare practices, legal frameworks, and societal attitudes. Moreover, the broader implications of euthanasia on medical ethics, patient autonomy, and the sanctity of life could be explored to provide a comprehensive understanding of the complexities surrounding euthanasia and the ongoing debates on its legalization and practice. A substantial compilation of free essay instances related to Euthanasia you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

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How To Write An Essay On Euthanasia

Introduction to the concept of euthanasia.

When embarking on an essay about euthanasia, it’s crucial to begin with a clear definition of what euthanasia entails. Euthanasia, often referred to as "mercy killing," is the act of intentionally ending a person's life to relieve them of suffering, typically from a terminal illness or an incurable condition. In your introduction, outline the various types of euthanasia, such as voluntary, non-voluntary, and involuntary, and the ethical, legal, and moral questions they raise. This introductory segment sets the stage for an in-depth exploration of the arguments for and against euthanasia and its implications in the realms of medicine, ethics, and law.

Exploring the Arguments For and Against Euthanasia

The body of your essay should delve into the complex arguments surrounding euthanasia. On one hand, proponents argue that euthanasia is a compassionate response to unbearable suffering, respecting an individual's right to choose death over prolonged pain. They may also cite the importance of dignity in death and the reduction of medical costs for terminally ill patients. On the other hand, opponents raise concerns about the sanctity of life, the potential for abuse, and the slippery slope towards non-voluntary or involuntary euthanasia. They may also discuss the moral obligations of medical professionals to preserve life. This section should present a balanced view of the debate, providing a comprehensive understanding of the various perspectives on euthanasia.

Ethical and Legal Considerations

A crucial aspect of your essay should be an examination of the ethical and legal considerations surrounding euthanasia. Discuss the ethical principles involved, such as autonomy, beneficence, non-maleficence, and justice. Explore how different countries and cultures view and legislate euthanasia, noting the variations in legal frameworks and the criteria required for it to be carried out. This analysis should provide insight into the complexities of legalizing and regulating euthanasia, and the ethical dilemmas faced by healthcare providers, patients, and their families.

Concluding with Personal Reflections and Broader Implications

Conclude your essay by summarizing the key points and offering personal reflections on the topic. Reflect on the implications of euthanasia for society and the field of healthcare. Consider how advances in medical technology and changes in societal attitudes might influence the future of euthanasia. Your conclusion should not only provide closure to your essay but also encourage further thought and dialogue on this sensitive and contentious issue, highlighting the ongoing importance of ethical deliberation in decisions about life and death.

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Mercy Killing Should Be Encouraged Essay

Introduction, mercy killing, works cited.

My Grandfather had been in the hospital for eight months whereby, visits to the hospital were of the most painful experiences that I have ever had; having known that, he was undergoing extreme mental and physical pain, of which I had little control over. To make it worse, I had painfully watched his health deteriorate day by day, bringing him to a state of hopelessness, with only one primary thing to live and endure; pain. Although we lived with hope, the doctors had made their verdict, because they had done all that was possible with no success. My prayers for his recovery seemed unanswered because; sometimes I could watch him hopelessly as he screamed loudly, due to the extreme pains that he enduring, with no help to offer. In addition, as I watched my grandfather closely, I could confirm that the once enthusiastic face was gradually losing interest in life. This worried me very much, as his ailment had reduced his life into a shell of suffering, making him loose hope and self-esteem. Sometimes the situation was too much for us to bear because, even recognizing his friends, and relatives (including me, his favorite grandson), was a problem. Hence, to end his long-suffering, we had to take the “cruelest” option of terminating his life, it being the only remedy we had. Surely, this was another most painful thing I have had to endure in my life, for I stood there helplessly as the doctor cut off his oxygen supply. As a transition to his new form of life, he struggled and finally stiffened with a weak smile on his face. Although five years have passed since then, the memories are still vivid in me; for I knew and I have always known that we made the right decision for him.

Mercy killing is a mechanism of relieving both the sufferers and their families from extreme pain and anguish; them being witnesses of such suffering (Grisez and Boyle, 509). Frankly speaking, my grandfather was enduring extreme mental and physical pain, which had left him a hopeless being, with one thing to live for; pain. This made me to question the purpose his living because; he was struggling to breathe even with oxygen tubes in his nostrils; hence a clear indication that we were forcing him to live against his wishes. In addition, our forcing him to live is questionable because; for which purpose was he living, when he could not even indentify himself, and had to endure such extreme pains? Considering this, it is not wrong for one to argue that, all we did was for selfish gains; that is, our fear of losing him overlooked the great pain that he was undergoing, as we forced him to continue living; hence, the importance of mercy killing.

Primarily mercy killing or euthanasia involves the ending of someone’s life either willingly or unwillingly. The entire process is painless to sufferers who are in a vegetative state; a case that is common in most medical scenarios, where medics; primarily doctors, have expressed no hopes of recovery of such patients. In addition, doctors mostly perform this operation to patients in extreme pain; hence, a merciful way of ending their anguishes and pain. For medics to carry out mercy operation, they have first to seek consent from such patients; if they are at a position of deciding for themselves, failure of which their relatives’ or close allies’ decisions take precedence.

Owing to the fact that, medics recommend this process to individuals who are experiencing extreme pain and suffering, and because it is not bad for one to endure emotional pain resulting from suffering of their loved ones, it is true that individuals sometimes make this process unnecessarily longer to people whose resting time has come. Therefore, although such individuals will have more time to see their loved ones, this increases the duration of emotional and mental suffering, and the magnitude of pain to sufferers. Further, it is important for all individuals to note that, such practices are not only delusional; hence making individuals to forego important aspects of their lives, but also they have many negative consequences, for example, trauma, family and occupational associated problems (Grisez and Boyle, 511).

To some extent, individuals’ lives can stop due to the failure or unwillingness to execute mercy killing. This is because; although such individuals may be sure that, it is that such suffering-loved ones have minimal chances of living, in most cases, they accept the reality of the situation after the demise of their loved ones, whom they never wanted to die. As the physiological fight or flight theory postulates, the human body has a natural control mechanism; mentally, physically, and emotionally energized; hence, giving individuals a way of dealing or adapting to environmental variations. In any life scenario, a change of environment encompasses change of circumstances in individuals’ lives hence, altering the common used to environments. Failure by individuals to adapt to such changes is a great impediment on individuals’ coping potentialities; hence leading to stress, which may result to dejection. Such scenarios are prevalent in most death-postponed cases, due to the fear of executing the mercy killing concept, despite the fact that, such cases direct individuals’ time and emotional resources towards a fruitless cause. In addition, the more individuals endeavor to cherish memories of their dead loved ones, the more their desperation worsens hence, leading to many negative impacts on individuals’ lives, more so the suffering. For example, for the suffering, such effects can commence with simple breathing problems, which becomes complex later on. Although medics always do anything at their disposal to save lives for instance, feeding of patients through the nostrils, whose failure leads to use of the most expensive pure oxygen, they fail to realize that, they are wasting resources on lives they are very sure they cannot save. On the other hand, analysis of the hospital environments, which includes an array of foot and air tubes and other patient supporting machinery, are clear evidences of holding on to a life that is desperate to rest. This fact is compounded by the expensiveness of the process not only to the suffering, but also to the supporting families hence, doing more damage than good (Heifetz and Mangel, 197)

Yes, to some extent the argument against mercy killing that, this process terminates one’s life, something that only God should do is right however, their notion lacks a base of expression. This is because; avoiding the practice primarily means that, individuals must use any artificial means to preserve life, a life that should rest naturally. Therefore, this causes one question; why should individuals aim to prolong life; something, which they lack control on? No wonder, such efforts are always fruitless, and only lead to desolation, disappointments, loss resources, and suffering. This is the case because, death is not a clinical thing, but rather a natural process (Manning, 99)

On the other hand, considering the fact that, most suffering individuals have to endure extreme pain, with surety of death in the end, majority of such individuals “die” even before their natural deaths. Therefore, mercy killing never denies somebody life, but rather the problem is these individuals’ inability to accept reality. In addition, considering the quantity of resources wasted in sustain such patients, it practically beats logic, because such families can use such resources on constructive things; primarily because, there is no need of family accumulating debts in the name of saving an un-savable life. In this regard, it is important for individuals to note that, life never lasts forever; hence, the importance of cherishing every day and concentrating in saving savable lives for example, through resuscitation; a fact that mercy killing supports (Manning, 101)

Another argument against Mercy Killing, which is refutable, is that, majority of individuals use Mercy killing as a mechanism of eliminating family members they do not cherish. This lacks some concepts of logicalness; hence, individuals cannot apply it as a rationale to oppose this practice. This is because; egocentrism is generally individualistic, a fact that mercy killing never encompasses. In addition, mercy killing is a practice done out of love and care for loved ones as mechanism of ending their suffering. On the other hand, it is important to note that, majority of individuals who prefer this practice value their loved ones to whatever they own; hence, through saying that they should use that money to prolong life is wrong, because, such prolonging is of more harm than good. This is common in life, because such efforts are always fruitless and more painful than mercy killing. Considering this, antagonists of this concept are selfish, because they are prolonging suffering of individuals; they claim to love (Jenkins, 195)

In conclusion, mercy killing is one of the most controversial concepts in nature. Although some individuals oppose the concept, most of them fail to recognize a few realties about it namely; medics execute the process in extreme suffering situations, where the hopes or recovery never exists. In addition, postponing one’s life wastes time, money, and it has other negative impacts to both the suffering individuals and their remaining families; which include depression, trauma, family and occupational problems. On the other hand, although the concept elicits many moral issues, it practically beats logic to preserve moral egos, rather than embracing reality. This is because, man has no power of prolonging life, but rather, avoiding mercy killing will imply that, individual love seeing others suffer.

Grisez, Germain, and Boyle, Joseph. Life and death with liberty and justice: a contribution to the euthanasia debate. Notre Dame: University of Notre Dame Press, 1979.Print.

Heifetz, Milton and Mangel, Charles. The Right to Die. Toronto: Longman Canada Limited, 1975.Print.

Jenkins, Joe. Contemporary moral issues; Examining Religions Series, (4 th e.d.). Portsmouth: Heinemann Educational Publishers, 2002.print

Manning, Michael. Euthanasia and physician-assisted suicide: killing or caring? Macarthur Boulevard, New Jersey: Paulist Press, 1998.Print.

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An Ethical and Judicial Framework for Mercy Killing on the Battlefield - copie

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Sensitive Topics: How to Write a Mercy Killing Essay

Don’t Forget to Study a Sample Argumentative Euthanasia Essay

If you have no idea how to approach the topic, you may try and find some examples on the Internet. Although it will be a really bad decision to copy/paste any of them and try to pass it for your own writing, reading one may provide you with the much necessary insight and help you get to grips with the issue. If you have a strong opinion on the subject, you should probably look for an example of argumentative essay that promotes another point of view – when you see how wrong the author is and in what respects, it will be easier for you to build up your own argumentation.

Your Own Take on Mercy Killing Essay

There are a lot of possible approaches you may use when dealing with the topic of euthanasia. But whatever opinion you share, don’t forget that you shouldn’t found your essay on emotions, no matter how much this particular topic asks for it. What you need is real argumentation, supported with facts, statistics, examples from real life and so on. For example, if you support euthanasia, you may mention the number of patients slowly dying of incurable diseases with no hope for recovery who could be otherwise spared the pain and indignity of their position if they were allowed to die. If you are against it, you may mention the examples of people waking up from coma long after the doctors had given up on them and told their loved ones that they may just as well pull the plug on them. Study a sample argumentative essay on the topic and think about the arguments presented by another person – maybe you can disprove them? As you may see, the possibilities are boundless, especially if you have a strong opinion on the subject in question.

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Responses To Questions On Morality And Abortion As Well As Euthanasia: Essay You Might Want To Emulate

Morality and Abortion

Expertly Written Article Review On Current Study To Follow

ARTICLE REVIEW: Euthanasia and physician-assisted suicide in dementia

Tomlinson, E., Spector, A., Nurock, S., & Stott, J. (2015). Euthanasia and physician-assisted suicide in dementia: A qualitative study of the views of former dementia carers. Palliative Medicine, 29(8), 720-726. http://dx.doi.org/10.1177/0269216315582143

Introduction

Physician Assisted Suicide And Euthanasia Essays Example

Physician-Assisted Suicide and Euthanasia

Euthanasia : Essay You Might Want To Emulate

Good research paper on euthanasia in islam, draw topic & writing ideas from this essay on physician assisted suicide in california, dare report.

Passive Mercy Killing

Justified Mercy Killing--A Case To Case Basis Research Paper Example

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Assisted suicide

Recently in the newspapers there was a man who killed his wife who was suffering from stage four cancer. In his defense, he said that the wife had asked him to kill her in order for her to stop feeling pain. The wife was no longer responding to pain medication and was in agony for several weeks. This act of mercy killing is called euthanasia.

Good Euthanasia Mercy Killing Or Murder Argumentative Essay Example

Free essay about should euthanasia be legalized, essay on euthanasia, research paper on pro-euthanasia arguments, you pick one of the questions argumentative essay sample, example of research paper on psy2000 final paper: on euthanasia.

Mentor’s Name

Example Of Physician Assisted Suicides Argumentative Essay

Example of essay on active and passive euthanasia, free argumentative essay on euthanasia, active euthanasia laws essay.

ACTIVE EUTHANASIA LAWS

Active Euthanasia refers to ending a person’s life without them feeling pain usually using painless methods in places where it is allowed. Mercy killing is not legal in most parts of the world though it is in some states such as Montana, Luxembourg, Oregon, Switzerland, Netherlands and Washington. This kind of death attracts a lot of controversy due to a crash with cultural and religious beliefs of various people (Snyder, 2006, p. 13). Though legal, mercy killing is not condoned unless in the event where it is meant to assist in a natural death or event that will eventually result in death.

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Focus: Death

Pros and cons of physician aid in dying, lydia s. dugdale.

a Department of Internal Medicine, Columbia University, New York, NY

Barron H. Lerner

b Department of Medicine and Population Health, New York University, New York, NY

Daniel Callahan

c formerly of the Hastings Center, Garrison, NY

The question of a physician’s involvement in aid in dying (or “assisted suicide”) is being debated across the country. This article adopts no one position because its authors hold contrasting views. It aims instead to articulate the strongest arguments in favor of aid in dying and the strongest arguments opposed. It also addresses relevant terminology and reviews the history of its legalization in the United States.

Physician aid in dying is a controversial subject raising issues central to the role of physicians. According to the American Medical Association, it occurs when a physician provides “the necessary means and/or information” to facilitate a patient’s choice to end his or her life [ 1 ].

This essay’s authors hold varying views on the ethics of aid in dying; thus, the essay explores the subject without taking a position. It addresses its terminology; history of legalization in the United States; arguments in favor of aid in dying; and arguments opposed.

Terminology

Physician aid in dying goes by many names. Perhaps the best recognized is “physician-assisted suicide.” Alternative terms include but are not limited to: death with dignity, doctor-prescribed death, right to die, and physician-assisted death. For simplicity’s sake, we use aid in dying (AID), although we recognize that there will be some who object, no matter the label.

A variety of factors have led to these various neologisms. Supplanting the word “physician” with “medical,” for example, makes it possible for non-physician clinicians to prescribe the lethal medications. Some advocates of AID prefer not to use the term “suicide;” they contend that AID is a medical practice, distinct from the act of suicide for a depressed or hopeless person [ 2 ]. By contrast, opponents maintain that the process of prematurely and deliberately ending one’s life is always suicide, regardless of motivation. Some insist that dissociating “physician-assisted suicide” from other types of suicide demeans those who die by suicide for other reasons, as if only medically-assisted suicides are legitimate [ 3 ]. People on both sides of the issue worry whether “aid in dying” or “assisted dying” might be confused with palliative, hospice, or other care of dying patients.

In the United States, physician-assisted suicide or aid in dying has always been carefully distinguished from euthanasia. Euthanasia, also called mercy killing, refers to the administration of a lethal medication to an incurably suffering patient. It may be voluntary (the patient requests it) or involuntary. Euthanasia is illegal in the United States, but voluntary euthanasia is legal in Belgium, Colombia, Luxembourg, and Canada. It is decriminalized in the Netherlands.

At risk of compounding terminology further, Canada legalized in June 2016 “medical assistance in dying” (MAiD), which includes both “voluntary euthanasia” and “medically-assisted suicide [ 4 ].”

A Brief History of Legalization in the United States

In the early 1900s, advocates argued forcefully for legalizing euthanasia, which was already being secretly practiced in the US. According to Jacob Appel’s work on this period, the eugenics movement strongly influenced discourse on euthanasia, and opponents of legalization tended to put forth practical rather than religious or moral arguments [ 5 ]. When efforts to legalize euthanasia failed, public discourse on the subject waned for many decades.

In the 1980s, the pathologist Jacob “Jack” Kevorkian began advertising in Detroit area newspapers as a death counselor [ 6 ]. He had studied the technique of Dutch physicians in the Netherlands, and created his own device with which patients could self-administer lethal medications. His first patient ended her life in 1990 while lying on a bed inside Kevorkian’s Volkswagen van. He went on to assist with some 130 deaths by suicide over the next eight years. In 1999, after Kevorkian publicly distributed a video of himself directly euthanizing a patient, he was convicted of second-degree murder and sent to prison. Although Kevorkian reignited national debate about dying, his off-putting approach and personal idiosyncrasies prevented his becoming a national leader on the issue.

Several of Kevorkian’s physician contemporaries filed suit against New York’s Attorney General, arguing that the State of New York’s prohibition against physician-assisted suicide violated the Equal Protection Clause of the Fourteenth Amendment. They argued, in effect, that the right to refuse treatment was effectively the same as the right to end one’s life. The Supreme Court ruled in response in Vacco v. Quill (1997) that there is no constitutionally-protected right to die. It left such decisions to the states. The Court also ruled in Washington v. Glucksberg (1997) that a right to aid in dying was not protected by the Due Process Clause.

Oregon became the first to pass its death with dignity law that same year. More than a decade later, Washington legalized AID in 2008. Montana decriminalized the practice a year later. Vermont legalized it in 2013.

In 2014, a young Californian named Brittany Maynard was diagnosed with an astrocytoma and became a spokesperson for the legalization of AID. She was a newlywed facing terminal illness, and her story quickly captured the public imagination. Her well-publicized death by lethal ingestion in Oregon in 2014 influenced her home state of California to legalize AID in 2015. This was subsequently followed by Colorado in 2016, the District of Columbia in 2017, Hawai'i in 2018, and New Jersey and Maine in 2019.

Pro Arguments

The two most common arguments in favor of legalizing AID are respect for patient autonomy and relief of suffering. A third, related, argument is that AID is a safe medical practice, requiring a health care professional.

Respect for Patient Autonomy

Bioethics as a discipline gained significant traction in the 1970s, at a time when the concept of patient rights was pushing back against physician paternalism. The philosophers Tom Beauchamp and James Childress, in their well-known textbook Principles of Biomedical Ethics, advanced four fundamental principles as a framework for addressing ethically-complex cases: autonomy, beneficence, non-maleficence, and justice. Of these principles, autonomy undeniably exerts the most influence on current US medical practice [ 7 ].

Autonomy refers to governance over one’s own actions. In the health care setting, this means a patient determines which medical interventions to elect or forgo. Patient autonomy serves as the justification for informed consent; only after a thorough explanation of risks and benefits can the patient have the agency to make a decision about treatments or participation in medical research. This logic, it is argued, naturally extends to AID; patients accustomed to making their own health care decisions throughout life should also be permitted to control the circumstances of their deaths.

Relief of Suffering

At its core, medicine has always aimed to relieve the suffering of patients from illness and disease. In the West, Hippocrates’s ancient oath pledged to use treatments to help the sick, but not “administer a poison to anybody when asked to do so [ 8 ].” In contrast, advocates of AID argue that relief of suffering through lethal ingestion is humane and compassionate – if the patient is dying and suffering is refractory. Indeed, some of the most compelling arguments made in favor of AID come from patients, such as Maynard, who suffer from life-threatening illnesses.

A Safe Medical Practice

Aid in dying is lauded by advocates for being a safe medical practice – that is, doctors can ensure death in a way that suicide by other means cannot. Aid in dying thus becomes one option among many possibilities for care of the dying. Although individual state laws vary, most propose a number of safeguards to prevent abuses and to provide structure for an act that some people will do anyway, albeit more haphazardly or even dangerously. Safeguards include requiring that a patient electing AID be informed of all end-of-life options; that two witnesses confirm that the patient is requesting AID autonomously; and that patients are free of coercion and able to ingest the lethal medication themselves [ 9 ].

Con Arguments

Although opponents of AID offer many arguments ranging from pragmatic to philosophical, we focus here on concerns that the expansion of AID might cause additional, unintended harm through suicide contagion, slippery slope, and the deaths of patients suffering from depression.

Suicide Contagion

The sociologist David Phillips first described suicide contagion in the 1970s. He showed that after high profile suicides, society would witness a broad spike in suicides [ 10 ]. This was particularly true for individuals whose demographic profiles were similar to those of the person who died by suicide [ 11 ]. Although Phillips’s work did not focus on AID, it has been corroborated recently by the spike in youth suicidality following the airing of Netflix’s 13 Reasons Why [ 12 ].

The publicly-available data from Oregon, however, reveal that in the months surrounding Maynard’s high-profile death in November 2014, the number of similarly situated individuals in Oregon who ended their lives by lethal ingestion more than doubled. Furthermore, from 1998 (when Oregon started recording data) to 2013, the number of lethal prescriptions written each year increased at an average of 12.1%. During 2014 and 2015, however, this increase doubled, suggesting that high-profile AID leads to more AID [ 13 ]. Although the data do not prove that an increase in AID causes more non-assisted suicide, a study by Jones and Paton found that the legalization of AID has been associated with “an increased rate of total suicides relative to other states and no decrease in non-assisted suicides [ 14 ].” They suggest that this means either AID does not inhibit non-assisted suicide or that AID makes non-assisted suicide more palatable for others.

Slippery Slope

Some opponents of AID express concern that once doctors are involved in the business of hastening patients’ deaths; they have already slid down the slippery slope [ 15 ]. Others suggest that the slope is best exemplified by an expanding list of reasons for electing AID. Refractory physical pain is no longer the most compelling reason for ending one’s life through lethal ingestion. Instead, cumulative Oregon data suggest that the vast majority of patients elect AID because they are concerned about “losing autonomy” (90.6%) or are “less able to engage in activities making life enjoyable” (89.1%). Some fear a “loss of dignity” (74.4%); being a “burden on family, friends/caregivers” (44.8%); or “losing control of bodily functions” (44.3%). Concern about inadequate pain control was the reason for pursuing a lethal ingestion in only 25.7% of cases [ 16 ].

Opponents also point to increasing calls in the US for euthanasia. In 2017, Senate Bill 893 was introduced to the Oregon State Legislature; it would have enabled patients to identify in a legal directive the person they wished to administer their lethal medications, effectively legalizing euthanasia [ 17 ]. Although this bill failed, the Oregon House passed HB2217 in 2019, which expanded the definition of “self-administer” to include options in addition to the oral ingestion of lethal drugs. The House also put forward HB2903, which seeks to expand the word “ingest” for lethal medication to “any means” and also proposes to expand the definition of “terminal disease” to include “a degenerative condition that at some point in the future” might cause death. It remains to be seen whether Oregon will become the first state to legalize euthanasia.

Although Belgium and The Netherlands permit both AID and euthanasia, the latter dominates. Over the years there has been a steady increase in acceptable criteria. Currently, patients who suffer from depression, dementia, or being “tired of life” may be euthanized. In some cases, minors may also be euthanized [ 18 ]. Published data from the Flanders region of Belgium highlights that vulnerable populations are especially likely to be euthanized. From 2007 to 2013, the largest increases in rates of granting euthanasia requests were among women, those 80 years or older, those with lower educational achievement, and those who died in nursing homes [ 19 ].

Depression in Advanced Illness

Up to half of patients with cancer suffer from symptoms of depression [ 20 ]. The elderly also suffer from high rates of depression and suicide [ 21 ]. Because depression often manifests somatically [ 22 ], if patients are not screened, clinicians miss half of all cases of clinical depression [ 23 - 25 ]. Opponents of AID are concerned that in Oregon, greater than 70 percent of patients who elect AID are elderly and have cancer, but fewer than five percent are referred to a psychiatrist or psychologist to rule out clinical depression.

Physician AID remains a controversial subject relevant to the care of patients. The Hippocratic model dominated medical practice for thousands of years. With the rise of euthanasia in Europe during the second half of the twentieth century, many began to rethink this stance, but hastening the death of patients still sits uncomfortably with many physicians. Although a number of medical societies have begun to reconsider their positions, the American Medical Association’s House of Delegates voted in June 2019 to maintain the organization’s long-held opposition to physician-assisted suicide and euthanasia [ 26 ]. Strong arguments remain both in favor and in opposition to the practice, and physicians have an ethical responsibility to remain informed on this timely issue.

Additional Information

Co-author Daniel Callahan, PhD, died after the first submission of this article.

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