EUTHANASIA AND SUICIDE
or
The best preparation for death is life
Claire Foster © 2006
Some definitions
Suicide
The deliberate ending of one’s own life.
Since 1961 in the
Assisted suicide
Giving someone the means to end their life
by their own hand. In
Voluntary euthanasia
Ending the life of another at their
request. This is lawful in
Involuntary euthanasia
Ending the life of another without their request. This might be thought to be morally right if someone is suffering unbearably; however if they are capable of asking to be helped to die and have not asked, it is hard to see how it could be right to go ahead and do it.
Nonvoluntary euthanasia
Ending the life of another who is unable
to request it. If a person is in persistent vegetative state (PVS
– in which the brain has disconnected from the nervous system, where the person
continues to breathe and circulate blood but is otherwise unconscious) this
sometimes happens. In the
Palliative care
Care of a patient becomes palliative when it is known that there is no treatment that will save his or her life. At that point, treatments that might prolong life without effecting a cure might be withheld or withdrawn. Utilitarians [link] may argue that withholding or withdrawing life prolonging treatment is the same as euthanasia because it leads to the same outcome. However, the intention of the person acting denies this. Life prolonging treatment would not be appropriate if it has become burdensome and futile, and should be stopped. This is not against the law. For example, there was a legal case of a young woman who was on a life support machine, fully conscious and competent, and she asked for the machine to be switched off so that she could die. The court permitted this.
Advance decisions
Colloquially known as ‘living wills’, these are documents drawn up by people whilst still competent, stating their wishes about treatment should they become incompetent. They may choose not to be kept alive aggressively, to have all treatments possible, or even to have their life ended. Doctors must take them into account (Mental Capacity Act 2005). A patient may state that he or she does not want to be resuscitated or given life prolonging treatment under certain conditions.
Moral thinking
What is the action of euthanasia or suicide trying to achieve? – death. Death is not a bad outcome; it’s something every living being will face; and we all hope it will be a peaceful, pain free and dignified death when it comes, for ourselves and for our loved ones. However, if the person seeking it is in fact seeking freedom from pain, then death is not a good outcome. A person free from pain is the desired outcome and death is a clumsy and dangerous tool to achieve that. Palliative care, physical, emotional and spiritual, may achieve freedom from pain.
Will anyone be harmed by it? – the friends and family of the one who seeks death, and wider society. No one is an island, and the deliberate ending of life of a family member or close friend is bound to affect everyone involved. Acts of suicide stay as painful memories for generations within families. Acts of assisted suicide or euthanasia affect the wider society: the law would have to be changed and then a cultural shift would take place. As one Dutch doctor put it, I agonised for a day over my first case of euthanasia; the second took about half a day; and the third, well that was a piece of cake.
Do those most affected by the action want it to happen? – the person seeking his or her own death clearly will. Care should be taken that the request isn’t in fact to be released from pain, or to stop being a burden on family and friends. In fact it’s hard to know how anyone would know when such a request was truly independent. Friends and family may want assisted suicide or euthanasia to happen, if they love the person seeking his or her own death enough and believe it is being done for the right reasons. Suicide is rarely seen in that light.
Some moral principles
The sanctity of human life: Is all human life sacred? Does this mean that all human life should be sustained at all costs? The one thing that is certain is that we are all going to die. At what point should doctors stop trying to keep a patient alive? Good palliative care should recognize when treatment to cure a person becomes futile, and he or she should be helped with painkillers and sedatives, or whatever is needed for a comfortable and peaceful journey to death. Sanctity of life can mean that life has an inherent value, not just a conditional one. People are valuable whether or not they are useful or wanted by anyone else. The principle is enshrined in law in the form of an absolute prohibition on the intentional killing of innocent human beings. It protects each one of us impartially and recognises our fundamental equality.
The common good: The meaning of a human life is inextricably bound up with others. Suicide affects all those who knew the person who took his or her own life. A request for assisted death will involve other people, placing demands on others, who have to accept the decision as valid and act on it. If the law was changed to allow euthanasia and assisted suicide, would some people think that they had to ask for it, if they believe they are emotionally and financially burdensome on their families?
Autonomy: This means ‘self-rule’ and only applies to people who are able to exercise judgment. If they are, their wishes about themselves and their bodies should be respected. But should they be respected at all costs? Do reasonable human beings have a right to ask for something that may harm others?
Proportionality: When care for a patient needs to change from acute – when it seeks to cure – to palliative – when it seeks to make comfortable – it means that a person is going to die, is being allowed to die. There is some debate that administering pain-relieving drugs can hasten death. This is contested by palliative care physicians who say that if you wanted to kill someone you would have to give them much higher doses – 50 times as much – to succeed. Even so, if the primary intention is to relieve pain, and a person subsequently dies, then intentional killing has not happened.
Preventing suffering: Is palliative care now so good that it is always possible to prevent suffering? If so, euthanasia and assisted suicide are not needed to get rid of pain. If not, should research focus on helping people suffer less, or helping people to die?
Respect for dignity: Nobody wishes to face incontinence and other forms of loss of control. Nurses in particular can ensure that whilst such physical dependence may be unavoidable, it never brings with it a loss of dignity. This is crucial for patients and for their families and loved ones.