Medical ethics has been developing and changing over the centuries. Previously, all people relied on the Hippocratic Oath, the basic principle of which is: do whatever you want, but do no harm. Hippocratic ethics of medicine proclaims that the doctor is the king and god and knows everything. Today, medical ethics is based on four ethical principles. Neither one of them is a leading one, as all are equal:
- Autonomy - the human right to control his/her own life, health and death;
- Charity (Beneficence) - the duty to always act in the interests of the patient;
- Non-maliciously (Non-malfeasance) - the principle of "do no harm";
- Fairness - all patients have equal right to assistance.
The Phenomenon of Euthanasia
Why is there a question of a good death in the context of medicine? In modern world, we observe two major trends. Firstly, there is a shift from paternalism to autonomy, which gradually develops into medicine, as well as a change of the medical approach to dying. In the XX century, a hospice movement developed, proclaiming the idea that even a dying man must be treated and provided with medical care. The causes of death over the years have changed greatly, so did life expectancy. Many technologies prolong life. We are able to replace numerous body functions. However, this creates additional issues (Lavi, 2007)
Among many medical, legal and religious issues, euthanasia occupies special. The phenomenon of euthanasia is a major issue in the social and legal awareness of the population. Because human life is a core value of modern civilization, the issue of euthanasia has acquired a different path. The value of human life in relation to all legal and moral realities of constructing any socio-legal problem (for example, death penalty, abortion, human cloning), in one or another way affects the right to life (Biggs, 2001).
Dr. Death Jack Kevorkian
Jack Kevorkian is the most famous advocate of euthanasia, who has actively put his views into practice. More broadly, he is known as "Dr. Death." This American doctor helped to die more than 130 patients. The patient made the last on their own: they pressed the button and got a fatal drug intravenously or through a facemask for breathing. This was Kevorkian’s own invention. Many times he was brought to court, but he sought to justify. However, he was imprisoned after the death of a man, who could not "press a button," and Kevorkian himself made him a lethal injection. The video of the procedure done by Dr. Kevorkian was broadcasted on television andwas the main argument of the prosecution. At the trial, Dr. Kevorkian made an official declaration that he considered euthanasia his professional and personal duty, and that, knowing that this practice was illegal, deliberately chose the civil disobedience path. In such a way, he was found guilty of murder (Whiting, 2002).
For the first time, the word "euthanasia" was used by Francis Bacon to refer to an easy death. He created it from the two Greek roots: "eu" - "good" and "Thanatos" - "death." Nowadays, under the euthanasia one understands the medical care for a patient suffering from an incurable painful disease, which includes a fast and painless termination of life. There is passive euthanasia, which is cessation of maintenance therapy, including disconnection from the life-support systems, and active euthanasia, which is the introduction of drugs that result in death or the transfer of such drugs to the patient for self-use. Euthanasia of animals is a widely adopted practice, and is considered a humane way to end the suffering of terminally ill pets.
Euthanasia of people in most countries is forbidden, but in recent decades, laws and court decisions, that discriminated euthanasia, mainly the passive one, were adopted in some U.S. states, Albania, Belgium, Japan, Switzerland, Luxembourg and the Netherlands (Lavi, 2007).
Kevorkian claimed: “The assistance in ending life is to become a "health service" for patients who wish to die. "Helping patients, I wanted to put an end not their life, and their suffering. This is to stop a crime" (Biggs, 2001).
Catholic Church remains the main powerful enemy that opposes the legalization of euthanasia. Despite the recent softening of the relative position with regard to passive euthanasia, the Vatican is still proclaiming that active euthanasia equates to murder on a par with genocide, abortion and suicide. Other Christian denominations generally share the same views, which is not surprising, because from the point of view of religion, life belongs to God not people, and God decides when people should die.. Still, the death penalty is not opposed by church.
However, non-religious and ethical assessment of euthanasia is not clear. For every argument "for" there will be the argument "against" (Whiting, 2002).
Supporters of euthanasia claim that nobody has the right to make terminally ill patients experience severe suffering, that the existence of vegetable state and pain experienced robs a person of dignity, that the patients themselves, were seeking to put an end to their suffering and often resorted to more gruesome methods of suicide than a painless injection.
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Arguments for Euthanasia
- Arguments for euthanasia are based on the underlying principle of the right to self-government, as people have a right to make their own decisions about actions that affect them. If this is true, no one has a moral right to prohibit suicide, and assist in its implementation.
- The second argument is that life is the highest value to anyone; but if there is unbearable suffering, and death is a deliverance from suffering, are we entitled to deprive a person of relief?
- Thirdly, helping someone to improve his state is always morally permissible. If the killing will improve one's state, and the person wants to be deprived of life, such an act may not be causing any undeserved harm to humans.
We also must take into account that some people live such a life that it is better to die than to live (people on life support system who live in a vegetable state). The procedure of killing is permissible if, instead of a cognitive person we see only the suffering body (Biggs, 2001).
The proponents of euthanasia state: “If the patient is conscious, aware that death is inevitable, no longer able to endure great pain and asks hasten death, and the doctor does not agree to do so, the suffering of the patient increases. In such a situation, lethal injection is more humane, because immediately stop the suffering of the patient” (Whiting, 2002).
Higher doses of painkillers have a "double effect": relieve pain and accelerate death. Is not this the same sacrifice, but only in a slow manner? (Jen et al. , 2006).
Disease can lead to degradation of the individual (like incurable genetic disease). If this happens, it will be impossible to apply euthanasia due to incapacity of the patient. Therefore, the delay of euthanasia in the hope for the invention of new drugs is not always justified.
Statistics clearly show that in many countries, euthanasia is supported by most of the population (even in countries where euthanasia is banned). Among health workers those, who are closer to the patient and have to deal with a patient in critical condition, are more tolerant with regard to euthanasia (Lavi, 2007).
Euthanasia, painless death, is a charity; it is good. When someone argues that euthanasia is perjury, they have never seen terrible suffering and pain of multiple cancer patients, paralyzed or diabetics. They have never seen flour of parents forced for months and years care for children who have atrophied CNS Care – moron, or the torment of families who have paralyzed relatives. They have never felt the pain of mothers who have a baby with an incurable disease. Experiences of people, who every day see suffering of terminally ill patients, is the most objective judgment. In many countries, doctors have long used passive euthanasia (disconnecting of the equipment that supports the patient's life).
The public believes it is valid. So how euthanasia might be considered immoral if it is acknowledged? Even the presence of a legislative ban is unlikely to have a major impact on the already established practice.
In addition, after the legalization of euthanasia numerous issues can be avoided with the law providing a clear list of conditions under which euthanasia is permissible, and creating a mechanism for controlling strict compliance with the requirements of the law.
However, there are no compelling moral arguments to justify euthanasia. This conclusion does not change the situations when it is necessary to decide whether to continue the treatment of the hopeless and painfully afflicted patients or not. For example, a person has no money to pay for treatment of two close people, one of them is in a coma, and the other needs expensive operation. This requires a choice in favor of euthanasia. Indirect evidence that the decision for euthanasia cannot be considered morally irreproachable conduct can be found in the way of its adoption. In countries where the practice of euthanasia has legal and orderly forms, special ethics committee makes relevant decisions. This is reached by attending the physician, medical staff and the hospital administration, priests, philosopher of ethics, lawyers, social security services, etc. It is a collective body, adequately representing the interests of the society and patients.
It is very important in at least two respects: adequately comprehended, it is the responsibility of unbearable heaviness and hence there is a need for collective distribution of responsibility; being an accepted ethical practice, it will ensure that no abuse takes place (Lavi, 2007). Analysis of the arguments "for" and "against" euthanasia shows that in this case, we are talking about an issue that cannot be solved in the framework of logically rigorous and empirically valid judgments. Ultimately, it is a matter of choice, which, while appealing to the rational arguments and seeking to clarify their reasons, however, precedes them. Euthanasia is a question of strict scientific knowledge only secondarily. First of all, it requires a choice to be made, which defines the meaning and direction of human actions.