Life - there is nothing more precious. Therefore, it should come as no surprise why the issue of euthanasia is one that many people are passionate about. In the following paper, I will argue in support of active euthanasia - the acceleration of death either by oneself or with the aid of a doctor. The main goal of this paper includes presenting a convincing argument that the use of active euthanasia is permissible. Another goal of this paper involves presenting a convincing argument that the use of active euthanasia may be preferable to passive euthanasia - letting a patient die either via withdrawing life-sustaining treatment or simply by withholding treatment. A sub-goal of this paper involves presenting an argument that active euthanasia is not always the moral route. There are instances in which patients should not be afforded the option of active euthanasia. Contrarily, there are cases in which active euthanasia is preferable, but active euthanasia must always be voluntary. Much can be learned about these end-of-life issues by examining the case of Nancy Cruzan.
Tragically, Nancy Cruzan was involved in a car accident that left her in a vegetative state. She was left with no cognitive abilities whatsoever. Her quality of life was nonexistent. Her family wanted the medical professionals taking care of her to withdraw treatment, namely her feeding tube, and allow her to die. Here is where the major problem arises. Prior to this case, passive euthanasia required the consent of the person in question. Family had no say in the matter. There needed to be clear and convincing evidence that euthanasia was desired by the person to receive it. In this case, Nancy Cruzan had a conversation with a close friend about end-of-life issues. This conversation occurred about a year before her accident. She expressed that she would like to die if she were to suffer a devastating occurrence that leaves her in an extremely vulnerable state. This was seen as insufficient evidence to euthanize Nancy. Years later, however, several of Nancy's friends gave testimony that forced medical professionals to allow Nancy to die. Her feeding tube was removed, and Nancy died 11 days later.
The case set a precedent for the practice of passive euthanasia. Passive euthanasia is regarded as being more acceptable than active euthanasia. Active euthanasia is not worse than passive euthanasia, as I plan to express. It well may be that active euthanasia is preferable to passive euthanasia. Consider the following scenario. Someone, let's call him Bob, is involved in a car accident and Bob is suffering. He is pinned under his vehicle and is slowly and painfully dying. Bob is begging to be killed and to be put out of his misery. A stranger at the scene of the accident has a gun. Would this stranger be morally justified in shooting the person who is suffering? There is a tendency to say 'yes'. In doing so, the stranger is alleviating Bob's misery and delivering Bob from torment. Furthermore, it is likely that this man will end up dying if the stranger does not shoot him. So, the end result is the same. By shooting Bob, Bob will suffer less. It is better to die with less suffering. Therefore, active euthanasia is permissible. Active euthanasia brings about less suffering to the patient.
An objection to the use of active euthanasia may involve the Hippocratic Oath. The Hippocratic Oath commands medical professionals to do no harm. One may say that the act of killing another is intrinsically harmful. This is a valid point. A valid response to this is that the Hippocratic Oath does not make it clear what is harmful and what is not. There is no objective formula that exists to clarify this. With that being said, perhaps the opposition will be satisfied with the following answer. A person in a vegetative state has no cognition. They have no sense of the status of their lives. They lack comprehension, reasoning, and memory. A person in such a state is incapable of being harmed. There exists nothing left to be harmed.
Similar to the previously stated objection, the opposition may claim that active euthanasia is wrong because it is killing. And, killing is always wrong. There are no exceptions when killing is justifiable. This view is misguided. Killing is justified in more than one instance. For instance, it is just to kill individuals who have brutally murdered others. There are not many people who would object to the killing of Osama bin laden. This example alone proves that a blanket statement like 'killing is always wrong' has no firm ground to stand on.
There is no doubt that if active euthanasia is to be accepted a social policy, it must be a social policy of restriction. It makes sense to have the option on the table for active euthanasia to be utilized. It must not be allowed to be utilized for casual reasons. In "Voluntary Active Euthanasia" Dan Brock offers four criteria to be considered for active euthanasia. They are (1) the patient must be provided with all relevant medical information. There can be no surprises here. A patient must have all knowledge necessary to give informed consent. (2) Requests for euthanasia must be stable and enduring. One must not receive euthanasia upon a single request. It must be consistently asked for. (3) Reasonable pain treatment measures must have been utilized. This is important because one may change their mind about killing oneself upon the alleviation of some pain brought about by treatments that do not result in death. (4) A psychiatric evaluation must be given. The patient must be in a lucid state. To allow a patient to be euthanized while that patient is depressed must never occur. The preceding is the moral route and it should be implemented. There remains an immoral route that should not be taken. Active euthanasia must never become available to all who desire it.
Those who object may argue that a person can do whatever they like with their body, and if they choose to end it, then that cannot be restricted. Our bodies are ours to do with them what we will, one might say. The problem with this idea is that euthanasia is carried out by someone else. Even if it was true that people are free to do whatever they will with their bodies, one is not entitled to demand others to carry out their desires.
Voluntary Active Euthanasia, or VAE, brings about several consequences that will benefit society. VAE is humane because it preserves human dignity. As we humans near the end of our lives, it is common to desire to control our circumstances in our final times. Through VAE, one is able to die with dignity - able to manage death and precisely how one will die. Death is unavoidable. As a society, we must come to terms with our mortality. Death need not accompany destruction and suffering. Because of VAE, patients are able to leave the world with some control. It is unnecessary for them to endure an unbearable amount of suffering.
Furthermore, VAE will be reassuring to those who are close to death. Even if one refuses to utilize VAE, the very option may bring a sense of comfort and alleviate one's fears. One can imagine a situation when panic sets in upon the realization of impending death. A common thought might be that I don't want my family to see me in such a helpless state. Through VAE, certain fears are calmed and one is more likely to be willing to accept inevitable death.
The opposition may claim that VAE is incompatible with the medical profession. Medical professionals should not kill. Their job is to heal, and not to end a life, one might say. There may be objections that respect for the profession is sacrificed through the implementation of VAE. The job of medical professionals is to alleviate pain and suffering. If a patient is suffering unbearable pain, mercy killing (at the behest of the patient in question) is not only permissible, but it is honorable as well. Medical professionals can maintain their dignity in knowing they have brought peace to a suffering individual.
Furthermore, it is feared that people will lose trust in medical professionals if they become killers. There is something intrinsically untrustworthy about those who kill, one might say. Medical professionals kill at the behest of their patients. Most do so with reservations. As Brock points out in "Voluntary Active Euthanasia", this practice is likely to increase the amount of trust patients have for individuals. Knowing that a doctor will comply with whatever a patient's decision may be cannot lead to mistrust. If a patient wants to allow nature to take its course and die naturally, the patient can take comfort in knowing this request will be respected. In addition, if a patient desires the doctor to aid in ending the patient's life, then the patient can take comfort in knowing that this request will be respected as well.
It is expected that some people will view medical professionals in a worse light if VAE becomes an accepted policy. People may be worried that the profession will lose its moral credibility. This point is not without merit. These critics must realize, however, that medical professionals undergo an emotional experience when considering VAE. Killing another is not easy. Furthermore, medical professionals are carrying out the dying wishes of others. VAE is not advocated by doctors. It is implored by patients.
VAE will not be desired by all. Those who do not desire it must refrain from condemning others for having a preference that they may not share. VAE may be denied from a personal standpoint. Those who deny it must consider it as a public option - an option that can be afforded to others. It is irrational to state that an activity should not exist because one does not agree with it. It is silly for an avid golfer, for example, to state that basketball should not exist because golf is more preferable. Likewise, one cannot seriously say that no one should be allowed to engage in VAE because it is not something that they would do.
There is perhaps a more moderate alternative to VAE that more people may be open to. Physician-assisted suicide can be seen as more virtuous than VAE. Concerning physician-assisted suicide, medical professionals are not forced to kill. An important difference between physician-assisted suicide, or PAS, and VAE, is that it is the patient that directly ends one's life. The medical physician simply supplies the necessary doses of medication. PAS grants the patients more control than VAE does. Thus, more people will likely be open to it. Trust in health-care providers is not at risk. The dignity and respect of the profession goes untouched. Furthermore, VAE may lead to a slippery slope in terms of ethics, but PAS will not. The actions rest solely on the patient. The decision to kill oneself is formulated based on the patient's own desires and is in no way advocated by the medical professional.
In a perfect world, there would be no death. There would be no discussion of euthanasia and end-of-life issues. Unfortunately, we do not live in a perfect world. We live in a world where we need to make difficult decisions. Those decisions are not to be taken lightly. The practice of euthanasia is one that alleviates misery - that eliminates suffering. The ethics of VAE will continue to be debated. We must keep in mind, however, that it is very easy to cast judgment on others from afar. We must imagine ourselves in the situation of others. It is only then that we can understand the rationality and morality of VAE.
Card, R. Critically Thinking About Medical Ethics. Prentice-Hall. 2004.