The problem of euthanasia occupies an important place among the many medical, legal, and religious issues. Because human life is a core value of the modern civilization, the problem of euthanasia has acquired especially high significance nowadays. Value of human life in relation to all legal and moral realities raises many social or legal problems (for example, the admissibility of the death penalty, abortion, or human cloning) in one or another aspect affecting the right for life to the rank of global problems of the present. Events of the past few years only prove the unchanging importance of the issue of euthanasia. In 2005, people of the United States engaged in the debate considering the death of Terri Schiavo, who was in coma induced by clinical death and subsequent irreversible brain damage for 15 years. According to the Court’s of the State of Florida decision made by the suit of Terri’s husband, Michael Schiavo, she was disconnected from the artificial feeding apparatus that resulted in her death.
Following this decision, America split into two camps of supporters and opponents of this so-called passive euthanasia (Calabresi 151). Considering all these facts, it is possible to say that the topic of euthanasia causes a mixed reaction in society. Attention to the problem of euthanasia has increased with the development of the technology sustaining people suffering from terminal illnesses. Relevance of this subject is difficult to overestimate as it is associated with the most valuable possession of every human being – life. Various debates on this issue regularly occur among psychologists, politicians, doctors, lawyers, and religious figures.
However, there is no clear answer to the question of justifying euthanasia. Thus, the main objective of this research is to understand the meaning of euthanasia, study its origins and history, consider the arguments for and against euthanasia, and analyze its practices in some countries in order to define its impact on patients and their families and answer the question of expediency of its permission (i.e. legalization) throughout the world. Results of the research will be used to prove the definite need for permitting euthanasia in medical practice as a measure of relieving people with terminal illnesses from suffering.
Euthanasia is the practice of terminating the life of a person suffering from an incurable disease or experiencing unbearable suffering in a painless or minimally painful form. This term was first introduced by the eminent English philosopher Francis Bacon. In his works, Bacon claimed that the doctor’s responsibility is not only to restore health, but also to relieve the suffering caused by the disease; when there is no hope of salvation, euthanasia itself is bliss (Dowbigin 23). Thus, euthanasia can be defined as an intentional act of the medical worker which is in line with a request clearly and unequivocally expressed by the patient or his/her representative to end the physical and mental suffering of the patient who is medically in life-threatening condition, resulting in his/her death.
The Practice of Euthanasia
For many primitive societies, killing old and sick people or (for nomadic tribes) leaving them in the wild was the usual norm. The practice of euthanasia was typical in ancient Greece, where suicide of people who have reached 60 years was highly encouraged. Plato wrote that the medicine is designed to take care only of the healthy both in terms of body and soul; death of physically weak ones should not be prevented. Socrates, Plato, and the Stoics from Zeno to Seneca justified the killing of very weak and sick people even without their consent. Moreover, they believed that if a man becomes weak and a burden to the society, it is his moral duty to commit suicide. However, Aristotle and especially the Pythagoreans were opposed to killing terminally ill people (Dowbigin 8).
Christianity has opposed euthanasia from the very beginning considering human life a gift from God. The position of uncompromising rejection of suicide and euthanasia was not disputed until the Enlightenment, when some doctors started talking about the need to alleviate the suffering of the dying people. However, only in the late 19th century, in connection with the secularization, the ideas about voluntary euthanasia, including the one implemented with the help of a doctor, became widespread.
In the 1930s, in Nazi Germany, euthanasia was carried out on a massive scale with respect to those who were considered a burden to society and lived a life not worthy of living. In 1939, Hitler decreed the registration of children suffering from hydrocephalus, paralysis, and deformities (five thousand of them were euthanized) (Burleigh 99). Subsequently, by another decree, tens of thousands of people with mental disorders were subjected to involuntary euthanasia (Cavan 31).
Euthanasia was universally considered completely unacceptable for a long time. However, the development of life-supporting treatment along with the statement of the value of autonomous choice in medical practice has led to the fact that the problem of euthanasia ceased to be a taboo. However, according to Euthanasia Research & Guidance Organization, it is legalized only in a few countries of the world. Switzerland became a pioneer in the legalization of coup de grace - the law was adopted in 1941. In 2002, Belgium legalized euthanasia, but did not specify how it may be performed. In the same year, a similar law was adopted in the Netherlands; however, the courts of this country de facto allowed assisting the suicide of terminally ill since 1984.
Japan legalized euthanasia in 1962, but in practice, the right to suicide under the law is extremely difficult to implement as it is necessary to perform complex bureaucratic procedures (McDougal & Gorman 88). Statistics shows that the Japanese interested in euthanasia prefer to act independently, without any support. In Colombia, the Supreme Court of the country approved euthanasia in 1997, but the relevant law was not ratified by the Parliament. Until now, in this country, euthanasia is considered a crime. In Australia, the law allowing euthanasia was enacted in one of the provinces of the country but was blocked by the country’s parliament.
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As for the USA, in 1977, in California, after the years of discussions, there was adopted the law on the referendum legalizing living wills according to which terminally ill people can get a document expressing their desire to turn off the resuscitation equipment. However, the official use of this law has failed since one of the conditions for the implementation of euthanasia was the psychiatric conclusion of the patient’s sanity. However, the American Psychiatric Association forbids its members to participate in such procedures. Another prerequisite is that euthanasia must be carried out by a doctor, which is also impossible since the American Medical Association adopted a decision to prohibit its members to participate in euthanasia. In 1994, euthanasia was legalized in Oregon, and in 2008 - in Washington (“World Laws on Assisted Suicide” n.p.).
It should be noted that in all cases mentioned above, euthanasia is understood as acceleration of the death of seriously and terminally ill person carried out according to his/her will or the will of his/her authorized relatives or friends. Thus, in order to analyze this matter thoroughly, it is necessary to study the term euthanasia from a scientific point of view. It is possible to distinguish active and passive euthanasia. Passive euthanasia is the refusal from life-supporting treatment when it is either stopped or never started. Passive euthanasia (discharge of terminally ill patients from the hospital) is quite common in medical practice. From a moral point of view, there is an important distinction between a situation where a decision not to start the treatment is made and the situation when the treatment is stopped. In the second case, moral burden of the doctor is more serious. However, if the doctor will hesitate to begin the life-supporting treatment in order not to get into a situation where it must be stopped, he may do even greater harm to the patient.
Active euthanasia is a deliberate act to interrupt a patient’s life, for example, by means of injection causing death. One should distinguish between such forms of active euthanasia as a murder (killing) out of compassion (when life, being a torment for the patient, is interrupted by another person, such as a doctor, even without the patient’s consent), voluntary active euthanasia, and suicide with the help of a doctor. In the second and third cases, the determining factor is a consent (or even a demand) of the patient. In the second case, according to the request of the patient, the doctor himself makes him a lethal injection, whereas, in the third case, the doctor gives the patient means by which the latter can commit suicide. Despite the fact that in most countries, including the USA, active euthanasia is prohibited by law, it still causes acute medical and philosophical discussions (“World Laws on Assisted Suicide” n.p.).
Currently, a dramatic struggle of lawyers, philosophers, doctors, sociologists, political scientists, and theologians is unfolding. Some of them argue that life is sacred and inviolable, while others claim that life should not be a painful and meaningless existence. The main argument of the supporters of active euthanasia is the human right to self-determination. According to them, nobody has the right to make patients experience severe suffering; the pain deprives a person dignity, and the patients seeking to end their suffering often resort to far worse ways of suicide than a painless injection.
However, the main problem arises in relation to the patients who are not able to decide to cease to live: those in a coma, the mentally retarded, and very young children. Relatives of such patients require moral sanctions besides legal support. They need a clear understanding of the moral permissibility and justification of euthanasia. The complexity of the decision is in the fact that from the standpoint of religion, in particular Christianity, euthanasia has no ethical justification. The dogma stating that only God has the right to take a life is absolute and does not allow any changes. However, from the perspective of secular morality, involving relativity and variability of ethical standards and assessments, both negative and tolerant attitude toward euthanasia is permitted (Paterson 93).
Traditional notions of the value of life and crime of murder, as well as the feelings of love and affection force people to negatively perceive euthanasia. Deciding to terminate the life of the closest person, even for his/her own good, is an extremely difficult step in the ethical sense. In order for this to happen, an interior reassessment of the situation must occur in the minds of relatives: the act of euthanasia should not appear as a murder but as a share of charity towards someone who needs help of this kind and whom nothing else will help.
Relatives of a terminally ill person often are in a position where they must decide which of two evils is bigger and make a choice in favor of a smaller one. Taking responsibility for choosing euthanasia, they are not entitled to treat it as a benefit. Painful experiences and severe moral conflicts become for them a payback for the decision on the necessity of euthanasia.
In general, it can be said that the problem of euthanasia refers to the category of those that cannot be resolved in morally impeccable manner due to the fact that the choice on offer must be done not between good and evil, but between the two kinds of evil. Most of the difficulties in the ethical e assessment of euthanasia come from the fact that its supporters are trying to put it to the category of benefits. However, euthanasia is neither good nor evil. It is as evil as, for example, the prison or the use of weapons during the arrest of the criminal. All these are the examples of forced evil that the state uses to avoid even greater evils. Death from disease is evil both when it is spontaneous and when caused by the active intervention of physicians who used euthanasia. However, in the latter case, it may look like a lesser evil, which allows eliminating severe physical suffering that would continue if euthanasia is denied.
Thus, it is possible to conclude that this practice still should be permitted, but under a very strict control both from government and healthcare organizations and only with permission of the patient and/or his relatives. This decision is supported by the fact that humanism must play a major role in matters concerning human life and well-being; if assisted suicide relieves someone from unbearable suffering, it may be implemented. The question concerning the worldwide permission (legalization) of euthanasia is not so simple as each nation has its own set of values, moral norms, and taboos. Political and financial situation in the country also plays a significant role in this matter. Considering all this, it can be said that the permission of the assisted suicide in all countries will lead to different outcomes in each of them. Moreover, in the case of full legalization of euthanasia, it may become the absolute evil.
Also, there will be a high danger of abuse. For example, in countries with poorly financed healthcare sector, euthanasia could become a mean of killing lonely elder people, children with disabilities, persons suffering from cancer and AIDS. Recognition of legality of euthanasia may also deprive the state’s incentive to fund research aimed at finding effective ways of treatment of terminal illnesses. On the other hand, it is impossible not to see that euthanasia exists in medical practice making it possible to conclude that it will be performed anyway regardless of the regulation.
In conclusion, it should be noted that nowadays, people live in a modern society; they know the rules of morality and are familiar with the idea of humanism. They do not live in ancient times and times of fascism. They came to the concept of the value of human life. Thus, the only manifestations of euthanasia in society may be voluntary and passive euthanasia performed under a strict control. It is necessary to formulate a clear and unambiguous legal standard according to which the patient has a right to know the diagnosis of his illness and its possible consequences, the risk of adverse outcome in the case of treatment failure, and the degree of hope for recovery. However, it is also required to avoid physical suffering of the dying even through the use of the measures that otherwise would be contraindicated.