Your best friend is dying. She is suffering from cancer of the
liver and has been given two weeks to live. The life-sustaining treatments she
is receiving are painful, embarrassing and invasive. The treatments will extend
her life by one week if she continues them, however she is terminally ill and
will not recover. She decides to exercise her right to refuse treatment and requests
she be moved to a hospice. This is approved and she is given a new room in the
hospice. Your friend is in extreme pain and cannot escape from round-the-clock
agony. She screams and moans in pain constantly and no amount of painkillers
can soothe her. She begs her attending Doctor to administer any form of
medicine that will induce her death and release her from the daily torture she
can expect for the next week before her illness takes her life. Her Doctor
looks at her miserable condition and apologizes, saying he cannot give her such
release due to the statement brought forward in 1973 by the House of Delegates
of the American Medical Association. This statement declares that intentionally
allowing an individual to die is, in certain cases, acceptable. However,
intentionally administering lethal drugs to end her suffering is “…contrary to
that for which the medical profession stands…” and is therefore, never
permissible. James Rachels claims that this statement indicates a moral
distinction between actively killing, and intentionally letting die (the
American Medical Association (AMA) deeming passive euthanasia morally
permissible while active euthanasia is prohibited). Rachels argues that “…there
really is no moral difference between the two, considered in themselves.”[1] However, I disagree
with him. There is something fishy about allowing one’s best friend to suffer
in extreme agony for a week before her death, and morally equating that choice
with bringing about the cessation of her pain and granting her a peaceful
passing.
I will argue there is a moral distinction between intentionally letting die
(passive euthanasia), and intentionally killing for mercy (active euthanasia).
That distinction being that active euthanasia is more humane and therefore more
moral than passive euthanasia, after the choice has already been made to cease
the “…employment of extraordinary means to prolong the life of the body”[2] (or if these means do
not exist). Identifying this moral distinction is important as it may
prompt the AMA to amend their euthanasia statement in order to provide more
humane deaths for those individuals suffering, due to fatal medical ailments.
In response to Rachels (as well as Michael Tooley, whom I will not address),
Bonnie Steinbock presents her opinions of the active vs. passive moral distinction.
She begins her argument with another important distinction: that of the right
to refuse treatment. She states that while each individual has the right to
refuse treatment to prevent the “unwanted interferences of others” upon their
body, this does not give the individual the right to die. Steinbock continues,
“Perhaps we ought to interpret the right to bodily self-determination more
broadly, so as to include a right to die; but this would be a substantial
extension of our present understanding of the right to bodily
self-determination…”[3] I am inclined to agree
with her. After treatment has ceased, the individual should have the right to
request active euthanasia. This would not be a choice of life or death, but
simply a matter of the timing of said death. After the patient has refused
treatment, the choice between active and passive euthanasia is simply a choice
of how long to allow the individual to suffer (from both the physical agony as
well as from the mental anguish of watching one’s death approach). Surely, most
rational individuals would agree that more suffering, (when within one’s
control) is less moral. Additionally, if this line of reasoning is accepted,
intentionally letting die, can be equated to intentionally letting suffer,
proving passive euthanasia much less moral than an active mercy killing.
It is understandable that humans are uncomfortable with intentionally killing
another human, as most people have an innate fear of death and view it as the
ultimate harm that may befall them. This innate ‘common-sense’ compels people
to think that living in extreme agony, is preferable to death. However, this
reasoning is unsound when applied to assisted suicide because the choice of
active or passive killing is not a choice between agony and death, it is a
choice between death, or agony and then death. Death will not be avoided by
either decision; agony is the only variable.
When a horse breaks it’s leg, the farmer shoots it to be merciful. He knows
that the horse’s body cavity is large and heavy, and if the horse lies down for
too long, the weight of it will slowly crush the creature’s lungs and kill it.
The horse will inevitably die because the leg will not heal in time to support
the horse and relieve the pressure on its organs. If the farmer were to allow
the horse to suffocate in the pasture, rather than to put it out of its misery,
he may be cited for cruelty to animals. However, in a parallel example offered
by Rachels, doctors are expected to act in a manner that is the polar opposite
from the farmer’s duties. Rachels discusses infants who are diagnosed with
congenital defects and other obstructions due to Downs Syndrome. These
blockages and defects require operation to save the child’s life, and
occasionally, the parents and doctors decide not to operate if the chance of
survival is unlikely. It is here that this example diverges from that of the
horse and farmer, because instead of humanely ending the infant’s existence,
the parents and doctors are required to, leave it in the pasture, so to speak,
and let the child die on its own. Anthony Shaw recounts,
…When surgery is denied the doctor must try to keep the infant
from suffering while natural forces sap the baby’s life away. …It is easy at a
conference, in a theoretical discussion, to decide that such infants should be
allowed to die. It is altogether different to stand by in the nursery and watch
as dehydration withers a tiny being over hours and days. This is a horrible
ordeal…(Shaw 1972: 52)
This is an especially chilling example, as all rational
individuals are opposed to the intentional killing of innocent infants.
However, all rational individuals should also be opposed to the cruelty (and to
be honest, the downright torture) of allowing a baby to die in such a manner.
Rachels feels strongly on the matter and says, “The doctrine that says that a
baby may be allowed to dehydrate and wither, but may not be given an injection
that would end its life without suffering, seems so patently cruel as to
require no further refutation.” [4] Why then, do we give the grace of a merciful death to
farm animals, but withhold such from our own dying infants? It would seem that
the only explanation be a terrible flaw in the AMA’s doctrine of euthanasia.
Jonathan Glover presents a case against all forms of euthanasia on the basis of
the “self-evident” sanctity of all life in his argument of The Sanctity of
Life. Here, Glover states that a death effects, a) the individual who has
died, and b) the family and friends of the deceased. Glover continues to claim
that regardless of if one views death as a harm to the deceased individual,
killing is always objectionable because it negatively effects the living. “When
a man dies or is killed…His family may always have a less happy atmosphere and
very likely less money to spend…(and) the community loses whatever good
contribution the man might otherwise have made to it…”[5] I believe Glover is
incorrect in his statement on all accounts. Let us consider a dying (and
suffering) individual who has refused continued treatment of his fatal
ailments, as applicable to Glover’s statement. Firstly, he claims the family of
such a man would be negatively affected by his death due to the lack of a happy
atmosphere. This is unsound because the family and friends of a dying man
are likely experiencing an unhappy atmosphere while he lives, due to the
empathetic, guilty, or depressed response they have to his suffering. This
atmosphere will likely improve once the man has died and his family and friends
are certain he is no longer in anguish. Secondly, Glover claims the
family with be burdened with financial hardship upon the man’s death, that they
would not experience were he to be kept alive. This is also untrue. If a man is
suffering a fatal condition, he will not be able to work and earn income for
his family. Not only will he cease to generate income while he lives and
suffers, but he will require the constant care of his family (in most cases he
will rely on his wife) and prevent his caretaker from working and earning money
as well. Additionally, whatever insurance compensation the remaining family
receives upon the man’s death, will more likely lift them from financial
hardships, than throw them into them. Lastly, Glover’s claim that the community
will lose the suffering man’s possible contributions upon his death is
incorrect. Firstly, a suffering man is no more likely to contribute to the
community than he is to grab his brief case and head off for a hard day’s work.
Secondly, the community could actually be suffering from his being allowed to
die. If the dying man has government health care, the community is essentially
paying for whatever care he receives after he refuses treatment and before he
dies naturally, needlessly. The community as a whole would benefit if he were
granted his request for lethal medication because it would be more
cost-effective and would sooner make available his room/bed in the hospital,
for a patient whose life might yet be saved.
In conclusion, the most appropriate and ethical solution to the moral dilemma
of euthanasia, is to grant the individual the right to die when nothing more
can be done to prevent his death, in order to allow the individual to avoid
suffering before his inevitable demise, if he so chooses In these cases, active
and passive euthanasia should be considered the choice of the coherent,
consenting patient, and active euthanasia should be considered more morally
permissible than passive euthanasia when a doctor or parent must make the
choice between the two. The American Medical Association thus has a moral
responsibility to retract their statement of 1973 and amend their doctrine of
mercy killing accordingly.
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