THE CONCEPT OF EUTHANASIA (GOOD DEATH):
In typical (or most paradigm) cases, euthanasia involves the following elements:
(1) Some person is killed or allowed to die;
(2) this person is terminally and irreversibly ill and would die soon anyway;
(3) this person suffers a terrible (physical or mental) pain (his or her conditions are for him/her intolerable);
(4) this person requests to be killed (or to be allowed to die);
(5) euthanasia is an act (or omission) of mercy; that is, the reason for killing (letting die) is to spare someone further excruciating suffering, and to provide this person with as "good death" as it is possible under the circumstances.
If an act (omission) is sufficiently similar to the case so defined than it still can be classified as an act of euthanasia (even if it is not a standard, or central, case of euthanasia).
SOME CONCEPTUAL DISTINCTIONS AND CLARIFICATIONS:
Active euthanasia involves deliberate (intentional) killing. Passive euthanasia involves allowing someone to die.
Voluntary euthanasia -- a person requests (or did explicitly request) to be killed (or to be allowed to die).
Non-voluntary euthanasia -- occurs when a person has not requested to be killed (or to be allowed to die) and did not request to be kept alive either.
Involuntary euthanasia occurs when a person has requested to be kept alive. It is plausible to assume that all cases of involuntary euthanasia are morally unjustified, they are cases of unjustified murder.
Euthanasia: one person kills another (=active euthanasia) or allows this person to die (passive euthanasia).
Assisted suicide: One person provides another person with the means that allows this person to die; the person who dies kills himself/herself using this means.
MORAL STATUS OF EUTHANASIA
Most people and legal, medical, and religious organizations allow various forms of passive euthanasia.
There is a serious ethical debate about moral permissibility of voluntary and non-voluntary active euthanasia.
Most people and organizations assume that involuntary euthanasia is always (or almost always) morally wrong . There are several reasons that can be used to show that involuntary euthanasia is (almost always) morally wrong.
Arguments against involuntary euthanasia
- Consequentialist considerations: This form of euthanasia would cause lots of suffering, anguish, disutility, and so on.
- Respect for autonomy considerations: It violates the autonomy of individual (Autonomy -- self-directed freedom, the governing of one's self according to one's own system of value convictions (in particular, moral convictions) and factual beliefs. Autonomy is respected when one gives an informed consent, i.e., consent given after full disclosure of risks, benefits, and alternative treatments to any proposed procedure, both in therapy and in medical experimentation. Law entitles patients to such disclosure, except for the cases of emergencies or when the patient is incompetent; in such cases proxy's consent is required.)
- Respect for rights: It violates human right; especially, the right to life.
Arguments for voluntary euthanasia
- It promotes the best interest of everyone concerned
- It respects autonomy of everyone who is involved; and
- It violates no one's rights. (This issue is open to a serious philosophical debate. Defenders of euthanasia argue that the right to life can be waved and so voluntary euthanasia does not violate this right. Opponents of euthanasia argue that the right to life cannot be waived.)
Rachels Argument from Consistency
1. There is no moral difference between killing someone (per se), and letting someone die (per se). [That is, other things being equal, killing is just as good (or just as bad) as letting someone die.]
2. In typical cases, the only difference between active euthanasia (AE) and passive euthanasia (PE) is that AE involves killing while PE involves letting someone die.
3. If (1) and (2), then in typical cases there is no moral difference between AE and PA.
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4. Therefore, in typical cases, there is no moral difference between AE and PA.
5. In typical cases, passive euthanasia is morally permissible. [This premise is granted by AMA and various religious organizations.]
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6. Therefore, in typical cases, active euthanasia is morally permissible. [from (4) and (5)]
TWO CASES IN SUPPORT OF (1): James Rachels, in his "Active and Passive Euthanasia" (The New England Journal of Medicine 282 [1975], pp. 78-80): offered two cases that seem to support premise 1
CASE I (Killing): Smith stand to gain a large inheritance if anything should happen to his six-year-old cousin. One evening while the child is taking his bath, Smith sneaks into the bathroom and drowns the child, and then arranges things so that it will look like an accident.CASE II (Letting die): Jones also stands to gain if anything should happen to his six-year-old cousin. Like Smith, Jones sneaks in planning to drown the child in his bath. However, just as he enters the bathroom Jones sees the child slip and hit his head, and fall face down in the water. Jones is delighted; he stands by, ready to push the child's head back under if it is necessary, but it is not necessary. With only a little thrashing about the child drowns all by himself, "accidentally", as Jones watches and does nothing.
Rachels argues that Smith and Jones did equally bad things. So, other things being equal there is no moral difference between killing someone (per se) and letting someone die (per se). (Rachels would agree that in many cases killing may be worse than letting die. But he would argue that, in those cases, there are other factors that make killing worse.)
THE CONCEPT OF EXTRAORDINARY MEANS OF TREATMENT
Ordinary means of preserving life are all medicines, treatments, and operations, which offer a reasonable hope of benefit for the patient and which can be obtained and used without excessive expense, pain, and other inconveniences. Extraordinary means of preserving life are all those medicines, treatments, and operations which cannot be obtained without excessive expense, pain, and other inconveniences, or which, if used, would not offer a reasonable hope of benefit" (Paul Ramsey:, Patient as a Person...)
Ordinary means for preserving life include "all medicines, treatments, and operations which offer a reasonable hope of benefit for the patient and which can be obtained and used without excessive expense, pain, or other inconvenience." (The Catholic Bishops of Florida, "The Pastoral Letter on Death ..." (see also, http://www.culturalcatholic.com/CatholicLivingWill.htm)
By this definition, insulin and antibiotics are ordinary means of preserving life only if they offer a reasonable hope of benefit. If the situation is hopeless, the insulin and the antibiotics are extraordinary.
Extraordinary means for preserving life are "all medicines, treatments, and operations which cannot be obtained or used without excessive expense, pain, or other inconvenience for the patient or for others or which, if used, would not offer reasonable hope or benefit for the patient." (The Catholic Bishops, the same letter)
Notice: This distinction is based on the concept of "reasonable hope of benefit?" It seems that to use this concept we must assume that, sometimes, it is overall not good (or beneficial) for a person to merely stay alive. In other words, it seems that this concept assumes that sometimes death is beneficial for a person.
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