I would like to start by saying that in the modern world medicine had made tremendous advances that allow us to save people from the most serious illnesses, let alone keep them alive as much as possible. Life-support systems allow doctors to keep terminally ill patients alive for an extended period of time, and this is exactly when one starts to think about the rationality of the medical ability to keep all patients alive. In the following essay I will argue that we should not keep all the patients alive and let terminally ill patients die. In other words, I will argue pro euthanasia in certain cases discussed further in the essay.
First of all, one needs to remember that euthanasia can be either voluntary or involuntary, implying that it can be with or without the consent of a patient. At the same time euthanasia can be either active or passive, i.e. via doctor’s initiative to end the life or doctor’s initiative to withhold treatment that will ultimately result in a death.
There can be four different types of euthanasia:
- Voluntary active euthanasia-assisted suicide.
- Voluntary inactive- do not resuscitate command from the patient.
- Involuntary active-ending a life of a patient without his/her consent. This one is typical in cases when a person cannot come to conscience.
- Involuntary inactive-doctor stops treatment and life support of a patient (Emanuel, 66)
- Indirect euthanasia involves indirect involvement of a physician or nurse practitioner, let alone pharmacist who participate in providing the means for a patient to induce their death. It would mean writing or filling out a prescription for a medication in quantities large enough to cause the patient’s death when consumed. Such kind of assistance is already legal in Oregon after the passage of Death With Dignity Act in 1994 (Keown, 270).
- Direct euthanasia involves direct involvement of a physician, nurse or a pharmacist who will to directly administer lethal agents to induce patient’s death. Direct euthanasia is not legal in the USA yet is legal in Europe (namely the Netherlands and Belgium).
- Non-voluntary euthanasia requires no full consent and fully informed request from the patient yet rather their surrogate, proxy such as relatives or parents. For instance, a person who remains in the coma for a long time and there is not a chance for them to become conscious; the doctor would apply euthanasia without their consent. Terminal sedation (form of palliative care) involves a combination of medically inducing deep sleep and stopping other treatment of a patient with the exception of medication of syndrome control. Typically a person dies.
As one can see there are many ways for the doctors to help these patients die and apparently we can make use of many ways to initiate mercy killing of terminally ill patients (Weenolsen, 140).
Euthanasia is never the end result of joy or contentment. Pain by its very nature makes us want to stop whatever actions we are doing to escape from it. When a person is likely to take his or her own life in the near feature it is called lethality. When dealing with a highly suicidal individual, it is not useful to directly address the lethality of their particular situation. Physical pain usually leads someone to commit suicide by getting someone to assist him or her in the act, for example, if someone is suffering from Aids. Assisted suicide (euthanasia) is the most common suicide for people suffering from various incurable diseases and sicknesses that are too painful for them to handle (Jamison 46). As stated previously, euthanasia depends largely on physical pain yet sometime psychological pain can also want many people to die (Moreno, 90).
Typically the doctor would first of all administer intravenously sedative sodium thipental or barbiturate potion to induce coma in a patient. Once it is certain that the patient is in a deep coma (which occurs only after a few minutes after the injection is administered) another shot is done to inject muscle relaxant which would stop the breathing and the heart and ultimately cause the death of a patient. As one can see from such practices, the euthanasia is administered with the amount of pain minimized to reduce the possible patient suffering to the minimum (Humphry, 202).
One of the articles that I would like to note is found at http://www.hospicepatients.org/questionable-death.html and is written by Ron Panzer.
The article states that there are many instances when terminally ill patients need to be killed or just let die. For instance, brain dead patients who do not have qualities pertinent to humans such as free will, thinking and reasoning need to be let die. The article provides various statistics on the issue of mercy killing with examples of assisted murder taking place among terminally ill with brain cancer. From the article I learnt that indeed there had been instances when patients were killed without formally requesting euthanasia. The article also stated “When pain was involved, 97% of patients stated they approved of increasing the dosage of morphine; 53% approved of physician assisted suicide (“PAS”) 24% approved of euthanasia” (Panzer, 4). The article also noted that in cases when patients are not able to make decisions, their relatives might get authorization to let their loved ones die.
Another article I found at http://www.leaderu.com/issues/fabric/chap06.html titled “Euthanasia” comments on the history of euthanasia and points out conditions that justify mercy killing in many cases in many countries around the world. The article debates the right to die and the philosophy behind that right. From the article I learnt that Americans nowadays were more accepting of assisted murder than they were some 50 years ago. The statistics regarding the pro-choice state that after the WWII only about 30% of Americans would support mercy killing, while in the 1990s there would be some 60% of Americans approving euthanasia. One learns that as soon as a person ceases to be a human being with rational thinking, reasoning, and the human will, it is ok to initiate mercy killing.
The reason why I chose these articles is because they provide a snapshot on the issue of euthanasia and allow one to get a different opinion on the pro-euthanasia topic. I personally consider these articles are useful and instructive and the way the material is presented in these articles is certainly conducive for better understanding of reasons why euthanasia should be viewed as normal and necessary for our society. Furthermore, these articles remove the bias of many counter-euthanasia supporter that euthanasia is punitive. On the contrary, these articles once again reiterate that euthanasia can be used only when there is no chance for a person to return to normal life without suffering and pain. Again, euthanasia should be based on the person’s desire to die before dieing from that incurable and painful sickness.
I personally work in a hospital and am aware of the conditions of the patients that we have. Many of our terminally ill patients (whenever their brain is dead) are still left on life support for legal and moral reasons. These patients have no chance at all to return to the normal life and can live only in a vegetative state: motionless, and unconscious. These patients suck family resources, the resources of our hospital and the resources of our society. Some families do not believe that their family member will never recover and insist on treatment that brings absolutely no results. Speaking about our hospital, I need to note that in our Neurological ICU there are only 16 beds which should be extremely useful for the patients with a hope of recovery, thus should be denied to the patients who have a dead brain and no hope of recovery. Numerous hospitals around the country and probably around the world have similar situations when resources are wasted on people with no hope of recovery (Dworkin, 65). These patients should not be given further resuscitation and just let die rather than kept beyond their ability to live.
CPR Resuscitation is defined as a set of various steps required for sustaining proper circulation of oxygenated blood to individual’s vital organs, and restoration of effective heartbeat. The majority of patients who require CPR are usually very sick and typically have conditions that without resuscitation can lead to death. It is no wonder that only a limited number of patients experience a positive outcome, which ranges from about 20% to 30%. Despite relatively poor outcomes, CPR is a standard care for patients who require it. Furthermore, it is assumed that in a situation of emergency a patient had already given consent to a CPR/resuscitation or any other medical treatment unless had previously stated an objection. Thus, one needs to understand that CPR is a unique therapy that is being applied to patients without their consent and withheld only upon the reception of their proper direction. Resuscitation is the successful outcome of an attempt to resuscitate, while the request to forgo resuscitation is called Do Not Attempt Resuscitation (DNAR) or Don’t Resuscitate (DNR), the two identical terms. One should understand that the right to request DNAR is based on the individual right to self-determination, assuming that the patient is competent and in clear mind. It is for this reason, the medical facilities always use CPR when the patient is found intoxicated or on drugs that alter thinking (cocaine, marijuana, LSD) since it is believed that the patient was not able to make a reasonable decision. One should remember that the right to have a DNAR takes precedence over the wishes of family members, children, or physician. Typically most hospitals ask the patients in advance about their preference on admission to that hospital. By the same token, certain schools accept children with the DNAR request as obtained from their parents or legal guardians.
Although the issue of euthanasia is highly charged from the emotional, moral and political point of view I have to note that we should allow people make their decision freely especially when they do not want to live and have no opportunity to lead a healthy lifestyle, let alone return to normal life.
While to some it might seem that euthanasia, palliative care and Do-Not-Resuscitate order are cruel since they involve withholding ventilation, hydration or nutrition, let alone involve direct application of poisonous agent, it appears that as the person reaches a critical point of wanting to die, and their major systems shut down, the person typically does not want to live just like he/she does not demand any ventilation, nutrition or hydration. Forcing a person to live would be unnatural since it involves activity done counter the person’s will. In the modern democratic society where freedoms of one person stop only when they start to interfere with the freedoms of other people, ending one’s life at their request certainly is natural and democratic (Dowbiggink, 342).
If terminally-ill patients want to die, but their close relatives do not allow them to, one should develop a proper procedure to assure that they can die. For instance, prior to being admitted to the hospital one should sign a certain document which would stipulate under what conditions the patients should be just let die. Once again, the document should accurately describe the conditions which would allow the hospital staff engage in euthanasia so that ‘mercy killing’ does not happen by accident.
Another argument pro euthanasia is that many countries or states around the world already practice it and find it perfectly legal and morally just. For instance in Australia after the passage of Rights of the Terminally Ill Act 1995, in Northern Territory one can practice euthanasia. In other territories euthanasia is still prohibited yet the case when in 2002 a group of relatives morally supported an elderly woman to commit a suicide, and was investigated by a police, laid no charges. Euthanasia becomes practiced in other areas, yet still one would usually go to Northern territories to get euthanasia when requested.
In Belgium, euthanasia became legal in 2002 yet because of the complex process authorizing euthanasia, it had been termed bureaucracy of death. Such legalization of euthanasia is expected to reduce the illegal euthanasia practices in that country. In Canada, assisted suicide (euthanasia) is still illegal while the suicide and attempt to commit suicide became legal already in 1984. In the Netherlands, the Termination of Life on Request and Assisted Suicide act was ratified in 2002. From that time one it became legal to practice euthanasia and physician assistance in dying under certain circumstances.
The reason why we should follow other countries on the matters of euthanasia is because it had proven rational and demanded by the majority of the population as well as it allow people to freely make their choices in all matters including their personal ability to end their life when it becomes unbearable. One should remember that euthanasia does not propagate killing, yet should rather be allowed only in extreme cases when the person has not a chance of surviving and willingly wants to die. Keeping the person alive against their will and supporting their lives at a time of great pain and suffering which in any case will end up in the patient’s death is inhumane and counter-human rights to a free choice.
The solution I see should be either voluntary-inactive or involuntary-inactive euthanasia. The patients or next to kin should sign a formal request as to what a doctor should do when a patient has no hope of recovery. Family members should sign the formal papers expressing the decision to prevent legal suits against medical institutions should they take a freedom to act according to their own judgment. There is no point of keeping all family members upset for an indefinite (extended) period of time giving them wrong hopes and expectations, so whenever it is impossible to save a patient, then one should be just let die.
One should understand that pro-euthanasia means that it can be practiced only after repeatable requests from the patient or in some cases from their legal guardians/relatives and only when the patient experiences much pain and suffering and is unlikely to return to normal social functioning. Some of the sicknesses like cancer progress quickly and cause much pain to the patients preventing them from enjoying the last moments of their lives. Allowing them to die when there is no way to save their life is probably the best solution as it would consider their last will.
From the utilitarian point of view euthanasia is also permissible if it will reduce the amount of suffering in the society or a community. There are cases when a patient spends several months in a coma and without a chance of returning to consciousness, while his/her relatives spend all their time and life savings on keeping them in a clinic. Assisted suicide here would certainly make the lives of all people happier here. By the same token if a person is suffering from pain, assisting them to die will certainly reduce their suffering and the suffering of their close ones (Manning, 132).
In conclusion, I would like to note that euthanasia of terminally ill patients appears to be a reasonable solution to the problems that terminally ill patients cause to their family, medical institutions and the society. Euthanasia will save family and hospital resources. It will allow the hospital staff to work more productively and efficiently. There are many patients who remain in the so called border state between the death and life, yet they also consume resources and the personnel’s attention, which in turn might because unavailable to people who actually need and want it. After all, in my opinion, it appears to be the best solution for the patients who neither die nor remain conscious. As one could see from the material presented above euthanasia can take several forms and is likely expected to be less painful than the amount of suffering that the patients who request euthanasia experience. Euthanasia respects the will of a patient to either live or to die and takes it into consideration at all time. From the utilitarian point of view, euthanasia helps to reduce the amount of suffering in the family and in the society. Once again, I will state that I support euthanasia as long as it is voluntary (requested by the terminally ill patient or there legal guardians) and there is no other chance for a patient to become healthy and normal.
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Panzer, Ron, Questionable Death, assisted suicide, mercy killing, http://www.hospicepatients.org/questionable-death.html, Accessed: Dec. 4th, 2005.
http://www.leaderu.com/issues/fabric/chap06.html Accessed: Dec 4th, 2005.
Moreno, Jonathan, Arguing Euthanasia: The Controversy Over Mercy Killing, Assisted Suicide, And The “Right To Die”, NY Random House, 2004.
Dworkin, Gerald, Euthanasia and Physician-Assisted Suicide (For and Against), Prentice Hall, 2003.
Manning, Michael, Euthanasia and Physician-Assisted Suicide: Killing or Caring?, Wiley and sons press, 2004.
Keown, John, Euthanasia, Ethics and Public Policy: An Argument Against Legalization, Barrons books, 2003.
Humphry, Derek, The Good Euthanasia Guide 2005: Where, What & Who in Choices in Dying, Penguin books, 2004.
Weenolsen, Patricia, The Art of Dying: The Only Book for Persons Facing Their Own Death, McGraw Hill, 2001.
Emanuel, Linda, Regulating How We Die: The Ethical, Medical, and Legal Issues Surrounding Physician-Assisted Suicide, Prentice Hall, 2004.
Dowbiggink, Ian, A Merciful End: The Euthanasia Movement in Modern America, Wiley and sons press, 2003.