Lecture 10: A Brief Summary

In the past, people lived shorter lives and most died at a relatively young age due to acute, infectious diseases (e.g. cholera, smallpox). Today, people live longer lives and most die of chronic, degenerative diseases (e.g. cancer, heart disease, stroke).

Euthanasia is the termination of a patient’s life in order to relieve him or her of suffering. A patient who undergoes euthanasia is usually terminally ill, and the procedure is usually carried out in the best interest of the patient.

In terms of the patient’s consent, euthanasia can be classified into voluntary euthanasia, non-voluntary euthanasia, and involuntary euthanasia. In terms of method, euthanasia can be classified into active euthanasia, passive euthanasia, and physician-assisted suicide.

Supporters of the right to die argue that people should be allowed the freedom to make end-of-life decisions for themselves. Opponents of the right to die, on the other hand, argue that we all have a duty to preserve life (which means that suicide and euthanasia should not be allowed).

There are 2 main arguments for voluntary euthanasia: respect for patient autonomy the argument from compassion

There are 3 main arguments against voluntary euthanasia: the sanctity of life principle the integrity of medical profession the slippery-slope effect

Respect for patient autonomy implies that terminally ill patients should be allowed to make end-of-life decisions based on their own values and judgments. Euthanasia is not ‘voluntary’ unless it is performed on a patient who has expressed a clear wish to die.

‘Informed consent’ is a key concept in medical ethics ‘Informed consent’ is a key concept in medical ethics. Patients who have to make end-of-life decisions must be provided with information about their diagnosis, prognosis, and treatment options available (including the side-effects of treatment).

‘Quality of life considerations’ are also an important aspect of medical ethics. There is the possibility that in some cases, the patients’ quality of life may have deteriorated to such a point that keeping them alive would be no better than allowing them to die.

The ‘slippery slope argument’ against voluntary euthanasia draws attention to the risk of abuse. Permitting voluntary euthanasia, on this view, would weaken society’s prohibition against intentional killing, and thereby undermine the safeguards against ending patients’ lives against their will.

In considering whether to legalize euthanasia, policymakers should: weigh the costs and benefits of legalization, explore ways to prevent abuse (if they are in favor of legalization), and explore other alternatives available.

In non-voluntary euthanasia, the patient is unable to express his or her preference (e.g. if the patient is in a deep coma and unlikely to regain conscious awareness). Family members usually have to exercise ‘substituted judgment’ and make end-of-life decisions for the patient.

In involuntary euthanasia, patients are killed against their will or without their consent. This kind of euthanasia is almost always considered morally unacceptable. Some even go so far as to say that involuntary euthanasia should be seen as the equivalent of murder.

In active euthanasia, death is brought about by a physician’s act, for example, when a patient’s life is ended by lethal injection. In passive euthanasia, death is the result of withholding or withdrawal of life-sustaining treatment.

In stark contrast to the conventional view (held by the general public and the medical profession), James Rachels argues that there is no morally significant difference between active euthanasia (killing the patient) and passive euthanasia (letting the patient die).

In Rachels’ view, the reason why killing is normally wrong is that dying is normally a great harm. But if it is in the best interest of a patient to die now rather than suffer a prolonged and painful dying process, then killing is no longer a wrong.

In physician-assisted suicide, the physician does not directly cause the patient’s death but enables the patient to choose the time and circumstances of his or her own death, usually by prescribing a lethal dose of drugs to the patient.

Many terminally ill patients are transferred to a facility called a ‘hospice’ where they are given ‘palliative care’ rather than life-sustaining treatment. Palliative care is an aspect of ‘end-of-life care’ which aims at maintaining the quality of life of patients by relieving their pain and suffering.

Proponents of end-of-life care argues that palliative management of suffering has effectively reduced the number of requests for euthanasia and physician-assisted suicide. As such, end-of-life care is seen by many as a better alternative to euthanasia.