Euthanasia life, death and a whole lot of controversy
Liang Huihui, Jason Tan, Sherwin Loh, Preston Wong, Wu Zhuoyi | 07S07B
Euthanasia (from Greek meaning “good death”) is the practice of ending the life of a person (or an animal)
because they are perceived as living an intolerable life. It is done in a painless or minimally painful way either
by lethal injection, drug overdose, or by the withdrawal of life support. Euthanasia can be accomplished either
through an oral, intravenous, or intramuscular administration of drugs. In individuals who are incapable of
swallowing lethal doses of medication, an intravenous route is preferred.
The following is a Dutch protocol for intravenous administration to obtain euthanasia:
Intravenous administration is the most reliable and rapid way to accomplish euthanasia and therefore can be
safely recommended. A coma is first induced by intravenous administration of 20 mg/kg thiopental sodium
(Nesdonal) in a small volume (10 ml physiological saline). Then a triple intravenous dose of a non-depolarizing
neuromuscular muscle relaxant is given, such as 20 mg pancuronium dibromide (Pavulon) or 20 mg
vecuronium bromide (Norcuron).
Active euthanasia refers to a physician painlessly putting to death some persons suffering from incurable
conditions or diseases.
Passive euthanasia, in contrast, refers to any act of allowing the patient to die, which may include failing to
provide necessary medication as well as taking a patient off life support.
Voluntary euthanasia occurs with the fully-informed request of a decisionally-competent adult patient or
that of their surrogate (proxy). This should not be confused with death after treatment is stopped on the
instructions of the patient himself, either directly or through a do not resuscitate (DNR) order. Enforcing a
DNR order has never been considered assisted suicide or suicide of any kind, at least in the eyes of the law.
Patients of sound mind have always had a right to refuse treatment.
Non-voluntary euthanasia occurs without the fully-informed consent and fully-informed request of a
decisionally-competent adult patient or that of their surrogate (proxy). An example of this might be if a
"patient" has decisional capacity but is not told they will be euthanized; or, if a patient is not conscious or lacks
decisional-capacity and their surrogate is not told the patient will be euthanized.
Involuntary euthanasia occurs over the objection of a patient or their surrogate (proxy). An example of this
might be if a patient with decisional capacity (or their surrogate) is told what will happen. The patient (or
surrogate) refuses yet the patient is euthanized anyway. This is generally considered murder. If a patient
slated for euthanasia changes his or her mind at the last minute, the doctor is categorically required by law to
honor that wish. In most other countries removing or denying treatment without the clear instructions of the
patient is usually seen as murder.
Terri Schiavo, USA, 2005
Theresa Marie "Terri" Schiavo was a woman from St. Petersburg, Florida whose medical and family
circumstances and attendant legal battles fueled intense media attention and led to several high-profile court
decisions and involvement by politicians and interest groups. Schiavo, then 26, collapsed in her home in 1990
and experienced respiratory and cardiac arrest. She remained in a coma for ten weeks. Within three years, she
was diagnosed as being in a persistent vegetative state (PVS).
In 1998, when it became legal to do so, Terri's husband and guardian Michael Schiavo petitioned the courts to
remove her gastric feeding tube; Terri's parents, Robert and Mary Schindler, opposed this. The courts found
that Terri was in a PVS and that she should not be kept alive. In 2003, the matter began to receive national
attention.
By March 2005, the legal history around the Schiavo case included 14 appeals and numerous motions,
petitions and hearings in the Florida courts, 5 suits in Federal District Court, a Florida legislation struck down
by the Supreme Court of Florida, a subpoena by a congressional committee in an attempt to qualify Schiavo
for witness protection, federal legislation (Palm Sunday Compromise) and 4 denials from the United States
Supreme Court
Despite intervention by the other branches, the courts continued to hold that Schiavo was in a PVS, and
would want to cease life support. Her feeding tube was removed a third and final time on 18 March 2005. She
died 13 days later at a Pinellas Park hospice on 31 March 2005, at the age of 41.
Arguments for and against euthanasia
AGAINST EUTHANASIA
a) Sanctity of life
All human beings are valued, regardless of race, gender, potential for achievement etc.
Deliberate taking of lives should only be allowed for cases of self-defense or legitimate defense of others
Lives should not be ended just because it appears to be the most efficient way of ending one’s suffering.
b) Slippery Slope (Fallacy)
Legalizing euthanasia might lead to increase in gray area between voluntary and involuntary euthanasia.
Accepting voluntary euthanasia could indirectly lead to increase in involuntary euthanasia, which would have
grave consequences.
Vulnerable groups such as the elderly, the sick etc may feel pressurized to request for “voluntary euthanasia”.
Doctors may start killing patients in the name of euthanasia to free up beds or to save health care cost.
Murderers may use voluntary euthanasia to justify their crimes.
c) Conveys wrong message to the society
Allowing terminally sick or elderly and helpless people to die voluntarily would be conveying this message
that it is better to be dead than sick or disabled.
Lives of such people would also be disregarded and viewed as more inferior to able-bodied people. (Disabled
= burden to society)
All human beings should be given the chance to live and enjoy living.
d) Not the best option
Diagnosis may be wrong, patient might not be terminally ill like what the doctor said.
Prognosis may be inaccurate; patient might die much later than predicted.
Doctor might not be aware of other non-fatal solutions to patient’s suffering.
Patient may feel that they are a burden to their kin and feel pressurized to request for euthanasia.
Patient may be too confused and distressed to make a rationale decision.
FOR EUTHANASIA
a) Pro-choice
Each has the right over his/her body and life, and should be allowed to die what time, under what
circumstances, as s/he choses.
Works on the basis that human beings should be as free as possible (autonomy), that they are independent
biological beings
b) Fair distribution of healthcare and resources
An entirely pragmatic argument, it states the resources should not be used on people who cannot be cured,
and for their own reason and by their choice, would prefer not to continue living.
In addition to letting the patient have what s/he wants, it frees up resources to treat people who want to live.
c) Euthanasia can be regulated
Though this process will be extremely difficult, proponents of euthanasia argue that some rules are better
than no rules.
Involves investigations into the patients psyche, and the parties involved, like their family and the implications
of their death
A time period should be set for reconsideration.
Also, ensuring that the patient receives good palliative care (support, compassion etc.) before a request is
considered, and of course, the decision must be voluntary.
Perspectives
Vitalism states that no cost is too great to keep biological life going. Utilitarianism values life on how useful it
is, and in some ways, states that only the strongest and fittest should survive. Autonomy is the right to selfdetermination, assumed to maximized self-interest. The question of “whose life is it, anyway?” is answered in
favour of the one whose life is in question.
These are just a few of the myriad stands one could take on the issues of euthanasia - many perspectives exist,
and there is none that prevails over the others. We explore the motivations and perspectives of the parties
that play a part in the discussion concerning euthanasia.
PATIENTS
1. Those who ask explicitly for the termination of their lives
They think that they are a liability to their families and the society (“I’m like a parasite sucking my family’s
blood to live”- a euthanasia patient). They don’t want to become a burden to their family members
They are suffering and have suffered enough… They think that death is the best way to put an end to the
sufferings that they’re going through’
I feel that life in this condition has no dignity - Rámon
They are tired of living on the same bed, looking at the same “scenery” around them, talking to the same
people, and are left feeling “trapped” and frustrated
“3 feet is an insignificant distance for any human being. But for me, those 3 feet keeps
me from reaching you, touching you. It is an impossible journey, an illusion, a fantasy”
There is no hope and future for them, all aspirations in life are lost and they feel incapable of doing anything,
like a dummy waiting for death.
What do you see in your future? Death. - Mar Adentro
They become mentally unstable, due to the reasons mentioned above
“I’m supposed to die, but I’m not dying.”
They want to die before they lose their sanity, or they feel that they have a right to choose whether they want
to live or die
“This is my life and I am free to choose my own beliefs”
“Life is a right, not an obligation”
2. Those who do not want to die
They feel that they are lucky because they did not die; they want to see the world before they die, no matter
how much pain it causes them.
Encouragement/support from their family members give them the will to live on
“I bear it for the sake of my husband. He’s cared for me selflessly”
They feel a purpose in life, and want to write their life story.
They think that God (in all religious contexts) has given them a chance to live, which means they have a duty
to live it to the fullest. Either that or they believe that a miracle would happen and they would be cured
3. Those who are incapable of expressing their decision to die.
Like Schiavo, they cannot think, talk, or feel, and, in most cases, what to do with them is left to the decision of
their family.
SOCIETY
For Euthanasia
- Should respect patient’s wish/desire to die
- Should not continue to suffer more (death is better
than continued sufferings)
- Belief of life after death (that patient would be
happier after death)
Against Euthanasia
- Thinks that the patient is irrational/rash and should
council him
- Thinks that it is immoral to kill a living person/to
strip his rights to live
- Family members are not giving him enough
care/encouragement/support
- Life is more than being able to move around and it is
precious
- Being influenced by religion
FAMILY MEMBERS
For Euthanasia
- They feel incapable of supporting the patient/
Patient is a financial burden
- They feel detached from the patient (“He no longer
smiles. I cannot feel his warmth”).
- The patient agrees to euthanasia and they want to
respect his views
- They have explored all available options, but to no
avail
Against Euthanasia
- They do not want to leave the patient, they do not
want him to die
- They think that the patient is not in the right state
of mind/is irrational “I don’t think what he’s asking for
is right, I want what’s best for him, it’s not rational to
die”.
- They think that allowing euthanasia to be carried
out on the patient would mean murdering the
patient/ reject the idea of euthanasia “I won’t give
anyone the permission to do it (euthanasia)”
- Family’s religious beliefs
“As long as it’s God’s will, he’ll have to go on living”
- Afraid of how people will judge them (people might
think they’re not giving enough care and love to the
patient and that they are murderers)
- “Only one thing worse than your child dying on youHim wanting to”
MEDICAL PRACTITIONERS
The one section of the Hippocratic Oath, taken by medical practitioners before embarking of their careers,
that is most invoked in the discussion of euthanasia states that a physician should “practice and prescribe to
the best of [their] ability for the good of [their] patients, and to try to avoid harming them”.
However, most issues today boil down to the practitioner’s personal belief.
In the Netherlands, euthanasia and PAS has been legalized in certain circumstances that consider the
patient’s conditions and prospects of improvement, his agreement and awareness of the situation.
RELIGION
- It comes with little surprise that most religions are not favourably disposed to the idea of euthanasia. Some
are forbid euthanasia explicitly—the Roman Catholic Church is one of the most active institutions working
against euthanasia.
- Practically all sacred texts have some command from God that essentially states that “you shall not kill”.
Deliberately putting a person to death, whether or not he benefits from his death, directly opposes this
command.
- Also, most religions argue for the sanctity of life – essentially, that human life is sacred. The idea goes along
the lines of God, being the giver of live, is the only one that has the right to take it away. Religions also view
human life as special as a creation of God, and the shortening of a person’s life being a direct interference with
God’s plans. Religions like Christianity also believe that man is made in God’s image and have a special value
and dignity regardless of one’s quality of life, and the taking of a life violates this value and dignity.
- Eastern religions like Buddhism and Hinduism see life as a cycle of birth, death and reincarnation, the
ultimate aim being to break free from such a cycle (known as moksha in Hinduism), and be released from the
material world. Lives and deaths of individuals played a part in deciding how their next lives would be lived out,
and each cycle brought one closer to liberation. The premature ending of a life would interfere with one’s
karma and consequently, one’s journey to liberation. Also, the belief of ahimsa or non-harm states that all
should avoid harming living things—including the killing of people regardless of consent from the individual.
Further Reading/References
Parts of the information presented in this write up have been taken from the following internet sources:
"Euthanasia." BBC - Religion & Ethics.
<http://www.bbc.co.uk/religion/ethics/euthanasia/>
"Legalizing Euthanasia: Medical Perspectives on Death and Dying." Santa Clara University.
<http://www.scu.edu/ethics/publications/iie/v4n2/euthanasia.html>
"Euthanasia." Wikipedia, The Free Encyclopedia.
<http://en.wikipedia.org/w/index.php?title=Euthanasia&oldid=67831104>.