Euthanasia

In a previous post, I reflected on some of the ethical considerations involved in abortion. My emphasis was placed on the understanding that an unborn child was entitled to rights alike any other person. What I neglected to discus in any detail was whether it was justifiable for a parent or doctor to assume the right to take life. I would like now to address this question in greater depth in relation to the question of euthanasia. Should individuals have the right to choose death and, if so, is it the role of the physician in assisting an incapacitated patient to this end?

Responsibility of the physician
The principle of non-maleficence (not doing harm) has been a core of medical ethics since the time of Hippocrates – the ‘father of medicine’. Under the Hippocratic Oath the physician swears:
“I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel…”[1]
I don’t believe you can remove the ethical foundational of the medical practice without weakening the entire structure, and history proves my point. In my view, this is sufficient reason to exclude physician-assisted suicide.

Right to take life
I think it is proper to be extremely hesitant to grant the power to take life to any person or institution, primarily because such power is so often abused. As Lord Acton famously stated, “All power corrupts; absolute power corrupts absolutely”.

Abortion, euthanasia and capital punishment all carry with them the risk that the power may be abused. It is by no means alarmist to suggest that this is likely to occur if euthanasia were legalized, as this is precisely what has occurred in the past. It was recognized at the Nuremberg trials that the Nazi euthanasia programs were a natural progression from mercy killings by German doctors in the 1920’s. Designating the right to take life detracts from a belief in the dignity and value of all life, creating opportunity for the violation of the human right to life.[2]

Right to choose death
I think the majority of people consider life to be the sole possession an individual. The argument goes: ‘It’s my life, so, assuming I am not compromising the well-being of others, it’s my choice how I use it, and my choice how I end it'. Putting aside the other issues of euthanasia, is suicide ethically defensible?

Personally, I think suicide undermines the dignity of human life and I also do not think that life is the agent’s possession.[3] Certain behavior is not just preferable but obligatory and, as such, freedom is secondary to morality. We have the power to take life, so in law we place restrictions upon ourselves to prevent the abuse of this power. Similarly, we have the power to end our lives and live our lives in a manner that is morally indefensible and here also the law is a tool by which this also should be restricted.[4]

Issue of Suffering
On a more philosophical and abstract note, I think suffering is first and foremost an existential problem and it can not be solved by physicians. I think legalizing euthanasia medicalises the issue, denying psychological, cultural and spiritual factors. Death is not the answer to the issue of suffering.

Conclusions
The Netherlands provides an interesting example of the impact of legalizing euthanasia. Initially, the law specified that the it must be carried out only on the terminally ill and only by consent. The first of these restrictions has now been removed. The second is also somewhat compromised, with almost six thousand reported cases in a single year of non-voluntary euthanasia.[5] Studies also show a complication rate of 23%. So much for that peaceful death.

It is entirely right that individuals maintain the right to refuse treatment, particularly as many drugs have potential side-effects. Physicians’ responsibility to care for their patients does not compel them to force beneficial medication upon them, but it does compel them not to force harmful medication upon them. To allow physicians this power undermines the medical profession and societies ethical foundations.



[1] Hippocratic Oath, 4th century BC
[2] Of course, there are cases where the right to take life is defensible and appropriate as it prevents the loss of life. This applies to abortion when the mother’s life is endangered and also in war.
[3] 1 Corinthians 6:19-20
[4] As clarification, the law is society’s tool, not the individuals. Refer to Robert Bolt’s play, A Man for All Seasons, for an explanation of why the latter can not be the case.
[5] Remmelink Report, 1991