Despite the growing support among doctors worldwide and significant advancements in the medical industry in recent years, there is still so much ambiguity surrounding the question of euthanasia and doctor-assisted suicide that “To legalize euthanasia or not?” is one of the most debated topics of the 21st century. This article attempts to discuss the ethics and morality of euthanasia by presenting the different viewpoints of both the advocates and critics of the legalization of euthanasia.
The moral permissibility and legalization of euthanasia are still in their infancy stages. Voluntary euthanasia is permitted in Belgium, Luxembourg, Canada, and the Netherlands, and assisted suicide is lawful in Switzerland, Germany, and the US jurisdictions of Oregon, Vermont, California, Montana, Colorado, and Washington DC if done by the rules.
This paper will elucidate upon the ethical aspects of euthanasia and deal with the highly debated question that whether “performing euthanasia is well within the natural rights of a human being?” Opponents of euthanasia have argued by giving some moral and ethical reasons, such as “the right to die is not within the permissible limit of human freedom."
Keywords: Morality, Legalization, Intrinsic Value, natural right
WHAT IS MORALITY?
The definition of Morality as described by Stanford Encyclopedia of Philosophy is, “descriptively to refer to certain codes of conduct put forward by a society or a group (such as a religion), or accepted by an individual for her behavior, or normatively to refer to a code of conduct that, given specified conditions, would be put forward by all rational people.
Black’s Law Dictionary does not define the term ‘morality’ specifically, however, it does define ‘morals’ –
“MORAL. Pertains to character, conduct, intention, social relations, etc. United States v. Car- roll, D.C.Mo., 30 r.Supp. 3, 6.
1. Pertaining or relating to the conscience or moral sense or the general principles of right conduct.
2. Cognizable or enforceable only by the conscience or by the principles of right conduct, as distinguished from positive law.
3. Depending upon or resulting from probability; raising a belief or conviction in the mind independent of strict or logical proof.
4. Involving or affecting the moral sense; as in the phrase “moral insanity”
WHAT IS EUTHANASIA?
The word “euthanasia” is derived from the Greek word ‘Thanatos’ which means ‘simple death.’ The definition of euthanasia according to the Merriam-Webster dictionary is “the act or practice of killing or permitting the death of hopelessly sick or injured individuals (such as persons or domestic animals) in a relatively painless way for reasons of mercy”.
TYPES OF EUTHANASIA
1) Active euthanasia refers to the practice of executing a patient using a deadly amount of drugs. This type of euthanasia is referred to as “aggressive” euthanasia.
2) Passive euthanasia is the purposeful removal of a patient’s artificial life support, such as a ventilator or feeding tube. Certain ethicists draw a distinction between withholding and discontinuing life support (The patient is placed on life support before being removed from it).
3) “Doctor-assisted suicide” refers to active, voluntary assisted euthanasia in which a physician assists the patient. A doctor provides patients with the resources they need, such as appropriate medicines.
THE CONTROVERSY RELATED TO EUTHANASIA
Life expectancy has risen considerably during the last several decades throughout the world. The average individual born in 1960, the first year the United Nations began collecting statistical information, could expect to reach the age of 52.5. The current average is 72. This trend is much more pronounced in the United Kingdom, where statistics have been preserved for a longer period. In 1841, a baby girl was anticipated to live only 42 years old and a baby boy to live only 40. A baby girl could live to be 83 in 2016; a boy, 79.
Nowadays, medicine and technology have advanced to such a level that deaths due to illnesses and aging can be minimized. Many people want to live a long life, but the debate doesn’t start there; the problem starts when people want to shorten their lives. Autonomy refers to a person’s ability to decide what affects their life, well-being, bodily integrity, and social connections. It refers to the ability of a person to decide what constitutes his or her “well-being”.
Health professionals have traditionally been staunchly opposed to life interruption, arguing that the medical role is to save lives. However, there is a significant inconsistency in this claim, because the “detachment of the apparatus” such that “life continues on its course” also known as passive euthanasia, is regarded as much more ethically permissible and a crucial the solution to alleviate pain and suffering.
The general question arises that is why people shouldn’t be allowed to shorten their lives if they want to and if they feel that their life isn’t worth living. The moment of death must be seen as a natural right of the patient and must be honored to preserve his dignity. Some say that such a wish cannot be entertained and that every life is worth living. Some people say that instead of accepting their wishes, society should try to improve their lives. When a patient is in psychological suffering, deciding whether or not their life has meaning is far more difficult; the former is much more elusive. Denying euthanasia deprives the individual of his or her dignity. If human dignity is predicated on autonomy, then restricting the right to freedom of decision and action violates the premise of human dignity. Various theories of ethics more or less align with the idea of passive euthanasia and thus permit it. Applying the sociological school of law to active euthanasia, it can be argued that if a person is in a persistent vegetative state or suffering unbearably due to old age or illness, and there is no hope of recovery, the right to die must be granted under the sociological permit it. Applying the sociological school of law to active euthanasia, it can be argued that if a person is in a persistent vegetative state or suffering unbearably due to old age or illness, and there is no hope of recovery, the right to die must be granted under the sociological perspective and the welfare objective.
Various theories of ethics more or less align with the idea of passive euthanasia and thus
Even if one goes by the principles of the natural theory of law, to some extent, euthanasia is permitted. Natural Law theorists have always argued about the recognition and respect for individual fundamental rights of the people. Even in the Notes on Virginia, Thomas Jefferson states, “that government may have regulatory authority over those rights that we have submitted to them, but that the right of conscience we never submitted, we could not submit.” All the basic, fundamental questions and rights of the individual are concerned only with the individual having complete autonomy over it. The state, the government, or even the community cannot encroach upon those fundamental autonomous rights of the individuals.
This, in the various scholarly opinions, is a reasonable argument for the advocacy of euthanasia when it comes to those suffering from psychological and physiological anguish. A simple yet logical argument can be raised that their request should be acceded to if medical specialists have been unable to assist them and have no reason to believe that they will be able to assist them in the future. An effort could be made to reduce or minimize their pain by providing palliative and hospice care. If there is even a small chance to save that person’s life, the doctor should try to do that. But an individual cannot feel how much pain a person is going through, and therefore it shouldn’t be decided by some random person whether a particular person should be allowed euthanasia or not. Now, if a conscious individual is suffering from an incurable sickness or condition that is causing him extreme agony, and chooses to die quickly and painlessly, it’d be counter-productive to believe that his life, or the life of any person, should be governed by decisions made by third parties. If people rationally conclude, after applying all kinds of solutions, that they want to end their lives, the government should let them do it.
Let us see an interesting case, the famous “lorry-driver case”
“In a burning vehicle, a driver is stuck. There isn’t a chance he’ll be saved. He’ll be burned to death in no time. A driver’s friend is standing by the lorry. This friend owns a firearm and is a skilled marksman. This friend is asked by the driver to shoot him dead. Shooting him will be less terrible than letting him burn to death. Should the friend shoot the driver?” (Hope et al. 2008, 185)
An individual with a rational mind, broad perspective, and compassionate approach can reasonably conclude that he should shoot him. Also, firstly, it should be confirmed whether there is even a little chance that the driver could be saved. But as this is hypothetical, there is no chance. But in a real-life situation, there is still a very small chance that he can be saved. But simple logic would tell us that there is no alternative, and if he does not shoot him, the driver will die a terrible death. And it can be expected that people will think similarly, if not the same, and reach a similar, if not the same, conclusion. There are two options: the companion shoots the driver or does nothing. However, it can be seen that doing nothing is far worse for the driver because he would suffer greatly if he was not shot dead. On the other hand, while shooting the driver is awful, it is preferable to letting him burn to death.
Various ethical views, to varying degrees, support the concept of passive euthanasia and so permit it. If the sociological school of law is applied to active euthanasia, it can be contended that if a person is in a permanent vegetative state or suffering incredibly due to old age or an ailment and there is no chance of improvement, the right to die must be allowed under the sociological perspective and the welfare objective. Even natural law permits euthanasia to a certain degree. Even some religious doctrines permit.
LEGALISATION OF EUTHANASIA IN INDIA:
The debate around euthanasia in India is always been complex and intricate. Keeping in mind that even the attempt to commit suicide is a punishable offence under Indian Penal Code, 1860, allowing a person in a persistent vegetative state (PVS) to die even passively by withdrawing life support can naturally be seen as something despicable and immoral. In 1994, in P Rathinam v Union of India, the apex court held that the “criminalization of attempt to suicide is unconstitutional.” However, later on in a landmark case of Gian Kaur v. State of Punjab, the Supreme Court took a myopic view of the Article 21 of the Constitution of India and overruled the Rathinam Judgment. But in an interesting situation, the court also allowed passive euthanasia to patients in Persistent Vegetative State (PVS).
The court observed,
“This category of cases may fall within the ambit of the ‘right to die’ with dignity as a part of right to live with dignity, when death due to termination of natural life is certain and imminent and the process of natural death has commenced. These are not cases of extinguishing life but only of accelerating conclusion of the process of natural death
which has already commenced.”
The Hon’ble Supreme Court in Aruna Shanbaug Case while observing the various legislations permitting passive euthanasia, recommended the government to consider repealing Section 309 of Indian Penal Code, 1860 which provides for punishment to an individual unsuccessful in suicide attempt. Aruna was a staff nurse at a hospital in Mumbai. One of the cleaners working there attacked her and strangled her brutally. This led to the cutting of oxygen supply and Aruna suffered critical brain damage. Due to this, she was in a persistent vegetative state (PVS). A petition was filed by a journalist friend of Aruna seeking permission from the court to let the doctors withdraw the life-support of Aruna so, she can die peacefully.
The Supreme Court in its landmark judgment drew a sharp distinction between Active and Passive Euthanasia. Although the court rejected the plea of petitioner, however, it accepted a broader interpretation of Article 21 put forward by the petitioner. And, in the end, it directed High Court to form a bench headed by the Chief Justice and give a speedy decision in the concerned matter. The apex court allowed for the legalization of passive euthanasia in only ‘rarest-of-rare circumstances’. This landmark decision ends the unbearable suffering and the trauma of the patient.
This judgment will act as a stepping-stone in legalization of the euthanasia in India, which is already legalized in some of the countries noted above in the discussion.
A reasonable individual can draw an analogy to think that the person requesting euthanasia is in the same situation as the driver blazing in the lorry’s case. Although there may be an objection that a patient cannot assess his disease and therefore cannot be permitted euthanasia. But it could be argued that medical knowledge and experience can tell us whether a particular patient can be saved or not.
Finally, some may claim that legalizing euthanasia violates the dignity of life because life is intrinsically and impersonally alive. The value of life is impersonal, and it is unethical to sacrifice it for the quality of another person’s life or any other value. By applying the same logic, it would be unethical to end this lorry driver’s life, even though it is not important to him or anybody else. To think about this philosophical puzzle, a question can be asked that, “Is the value of life always above all other values?”
Let’s consider an interesting thought experiment by Steve Luper:
I know how to cast two magical spells. One of them, which Jane wants me to use on her, would ensure that she has a life that is extremely good and far better than the life she otherwise would have had, but the spell will also kill her painlessly in her sleep one day sooner than the day she otherwise would have died of old age. The other spell, which she has forbidden me to use, would not kill her but would ensure that she has a life that is wretched and far worse than the life she otherwise would have had. (Luper 2009, 186)
The spell Jane wishes to cast on herself, will although kill her one day earlier than her typicaldeath date, but it will also assure that the rest of her lifetime will be wonderful. If human life has inherent value that cannot be traded for anything else, then casting the first spell is wrong because Jane’s life would be exchanged for her quality of life. However, when considering the rewards, performing the first spell is entirely moral and will be preferred over casting the second. As a result, the notion that human existence has inherent value finds it difficult to accept the consequences.
Let us now see Luper’s second thought experiment:
I have an illness that will kill me within a week if allowed to progress. There is a treatment that will extend my life by one more year, but I will be in pain nearly the entire time. I weigh the extra time against the pain involved and decide to refuse the treatment. I die three days later. (Luper 2009, 187)
If someone chose to live a shorter life to avoid pain in this scenario, and considering that life has an absolute intrinsic value, then this is an immoral act because living longer is more valuable than avoiding pain. This, however, is not how humans think. Also, in real life many cancer patients refuse chemotherapy as they think that therapy is more painful than death itself. In that case, people feel that refusing therapy is perfectly sensible and moral.
OBJECTIONS AGAINST EUTHANASIA
In Euthanasia, A kills B for B’s benefit and at B’s request. Some people might even argue that palliative care and hospice care may help the suffering patient and he can be saved. Some revolutionary technology may be invented to cure and save him.
The opponents of the legalization of Euthanasia argues
1) The right to die is not within the scope of an individual’s rights. Humans lack the moral authority to make decisions about death. Euthanasia is not permitted since it involves one person killing another.
It is irrational to claim that the right to die infringes on the moral right to personal freedom. As a society people are allowed to drink alcohol and smoke, which ultimately results in cancer, which is incurable in some cases. Society doesn’t feel like stopping them. Also, people are allowed to take on risky jobs such as soldiers, police officers, or firefighters. They are accepting voluntary risks to their lives.
A firefighter risking his life voluntarily to save a person is seen as a laudable act rather than a morally deplorable one. In the same way, a soldier who is martyred is also seen as a proud moment for the country. Most of the population would not charge these people with any wrongdoing. People would be much more likely to admire their sacrifice if they judged it morally. They also don’t blame people who jeopardize their health because of their lifestyle choices, such as smoking or participating in extreme sports.
Today humans use conception for population control; which in a way is controlling the natural event of the birth of an individual, which is well beyond the right to freedom.
2) The legalization of Euthanasia will lead us on a slippery road where it may result in involuntary euthanasia or even medical murder.
The slippery slope issue differs significantly from the previous arguments. This argument is also sound in its logic and is backed by results seen in Canada. This argument is put forward keeping in mind the situation of Canada. In 2016, Canada introduced a law termed Medical Assistance in Dying (MAID). Initially, it was permitted for adults who were terminally ill and their death is foreseeable in the next 6 months. Later on, in 2021, it was permitted for people having only chronic physical ailments to add on to terminally ill patients. Now there is a deliberation going on regarding it being permitted for people suffering from chronic mental illness. For some, this may be considered a ‘Slippery Slope’ as the data suggests that in approximately 6 years 41,000 people opted for MAID. However, while analyzing the numbers, it can be observed that out of all the people opting for MAID 97% were terminally ill i.e. most likely to die within the next 6 months. Some even argue that this assumption of ‘6 months’ is purely subjective. But the treatment, the opinion is taken by learned physicians backed by laboratory reports, and always the individual has the last say. Only 2.2% of patients were having chronic illnesses rather than terminal illnesses. Also, the average age of people applying for MAID was above 75.
A curious case is of the Netherlands where the same treatment is permitted but with more diligence. The government has formed regional boards assessing each permission for assistance in dying. The government’s annual report in 2019 showed that only 0.06% of the total deaths did not adhere to the criteria laid down by the medical board. Although this argument says that euthanasia should not be practiced, it does not state that euthanasia is inherently evil. It assumes that the legalization of euthanasia would result in adverse consequences of medical murder. Australia legalized euthanasia and there is a record of data showing that so far it succeeded. Also, some studies are showing that patients are being terminated without their explicit consent. The study says that the patients were not able to express their will because, for instance, they were in a coma.
These were instances of so-called non-voluntary euthanasia, which is typically used on patients who are unable to articulate their preferences and hence do not die against their will. There is no information about how many cases of “a patient’s life ending without their explicit agreement” were reported in nations where euthanasia is still considered murder but terminal sedation is permitted because they are not tracked. It is yet too early to tell if a legalized euthanasia system is better or worse than an illegal euthanasia system in this regard.
Non-voluntary euthanasia should be legalized in some circumstances, particularly those involving persons who would never regain consciousness.
3) Euthanasia should not be used because it is unnecessary. It is unneeded due to the effectiveness of supportive and palliative care, as well as the ability of patients to refuse meals and drinks and thus die without assistance.
Some argue that euthanasia is no longer necessary because palliative and hospice care have advanced to the point where they can considerably alleviate patients’ suffering. It is not to imply that palliative or hospice care is inherently bad. It is critical for persons whose quality of life is likely to deteriorate to pursue such therapeutic options if they so desire. Every individual who chooses to try those treatments rather than dying should be encouraged wholeheartedly, as every possibly beneficial option should be investigated and tested. Hence, palliative care should be given more attention.
However, it is ultimately up to the patient to determine whether or not palliative care is beneficial to them; they can determine whether or not it makes their life worth living. Even though palliative care might alleviate a patient’s pain, it may come at a price that the patient is reluctant to pay. It is likely that by the time the physician discovers a pain management plan that helps a specific patient, the patient will have gone through a protracted period of experimentation during which their pain will remain unabated and their quality of life will remain unchanged.
If a patient chooses to die with medical assistance because they do not want to pay for hospice care and would not like to spend the remainder of their time with such a terrible quality of life. Patients who were offered the choice between high-quality palliative care and physician-assisted dying favored or would choose the latter, according to studies.
If there is a belief that legalizing euthanasia may entail harmful consequences in the current situation, situations may improve in the future, creating the ideal conditions for legalizing euthanasia. Moreover, euthanasia is morally justifiable and therefore should be legalized, and it should be the endeavor of the NGOs, social workers, and government to make it.
It can be deduced from the above arguments and discussion is that debate surrounding the Euthanasia is still in the infancy stage. There aren’t any significant results available to say whether active euthanasia should be permitted or not? However, it is agreeable to one aspect, that people suffering from terminal illness such as in Aruna Shanbaug case where she was in a Persistent Vegetative State for the last 42 years, should be given permission for passive euthanasia in order to free from unbearable suffering they undergo. Also, as can be learned from Luper’s experiments in a particular situation it is perfectly moral to assist someone in dying. It can be concluded readily that passive euthanasia is perfectly moral and ethically permissible and hence, should be legalized at least in the case of terminally ill and chronically ill patients. Some positive results of passive euthanasia can also be seen in Netherlands and Canada
On the point of legalization of active euthanasia, instant legalization is not only not possible but also not feasible. Instead, certain conditions can be developed and mustered where it can be ensured that when legalization is done, it’ll not go on a slippery slope. In a nutshell, euthanasia must be legalized in the future, if not now and appropriate precautions and care should be taken while doing it.
2nd year, Gujarat National Law University