|EUTHANASIA SHOULD BE LEGAL|
life is it anyway?
It is easy to find support for passive euthanasia, which means to
‘let people die because their lives are an unnecessary burden to them’.
Even the most pedantic opponents against the legalisation of euthanasia
would not find themselves in favour of employing every technical means
available to prevent someone from dying whenever he can be hauled back
from death (I am assuming that the opponents I am dealing with are not
unreasonable fanatics who cannot see the appeal of such a case). The crux
of this debate lies more with the moral permissibility of active
euthanasia, ‘an active intervention by a doctor to end life’, which is deemed more
abhorrent than passive euthanasia. I am arguing for the legalisation of
both active and passive
distinction between Active and Passive Euthanasia?
The reason that people are less likely to accept active euthanasia
is that they view it as a form of killing as compared to passive
euthanasia, which is more akin to letting the patient die. Opponents claim
that since killing is inherently bad, active euthanasia is necessarily so
as it requires someone taking deliberate steps to end life, as in the case
where the doctor administers a lethal dosage of drugs to patients to bring
forth death. Passive euthanasia, on the other hand, involves an omission
on the doctor’s part to give the appropriate treatment which then leads
to the patient’s death. Is the latter really less morally reprehensible
than active euthanasia?
doctor obeys the patient’s wishes and turns the life-support machine
off, he is not necessarily more culpable than one who does nothing to help
the patient when her life-supporting machine is turned off accidentally by
the cleaning lady.
Yes, there might be a difference between intervention and lack of
intervention but morally, these two doctors should be equally blameworthy.
Extending this line of reasoning, it goes to show that if the
public is ready to accept passive euthanasia, there is no reason why
active euthanasia should be condemned since they are to be regarded as
Right to Die
When we talk about having a right to die, the cases of two young
women, Karen Ann Quinlan
and Nancy Beth Cruzan,
come vividly to mind. After imbibing some alcohol with drugs, Quinlan sank
into a persistent vegetative state and was put on a respirator. Her
parents had to go through a prolonged legal battle to get permission from
the court to remove the breathing apparatus. Cruzan too, suffered a
similar fate and was kept alive by a tube into her stomach providing
nutrients and water. She was kept in such a state for seven years before
the court decided to free her from her meaningless existence in 1990.
The significance of these two cases lie in the courts’
recognition of a legal right to die that stems from the Fourteenth
Amendment’s Due Process Clause which protects liberty interests:
State shall make or enforce any law which shall abridge the privileges or
immunities of citizens of the United States; nor shall any State deprive
any person of life, liberty, or property, without due process of law; nor
deny to any person within its jurisdiction the equal protection of the
Chief Justice Rehnquist in
Cruzan’s case stated that “a competent
person has a constitutionally protected liberty interest in refusing
unwanted medical treatment”. ‘Competence’ is an essential
requirement for the courts to consider before declaring the legality of
‘voluntary euthanasia’. Only
a competent patient who can appreciate the circumstances surrounding his
condition can give an informed consent to the withdrawal of medical
treatment. And nothing should stop him from getting assistance from a
physician to administer a lethal injection to hasten his death.
of the patients who are incompetent, as in Quinlan’s and Cruzan’s
case? Lawful surrogates who can show some evidence, such as living wills
or advance directives, to support their interpretation of the patient’s
supposed wishes may be the answer. Opponents would protest against this
suggestion, arguing that this practice is open to abuse since the lawful
surrogates might be propelled by ulterior motives, especially in cases
where they stand to gain from the patient’s death. Desperate despondent
families might give up too quickly and try to end the misery of their
My retort is that this potential abuse is not limited to
euthanasia situations. A cancer patient who is not in the terminal stage
of his illness may similarly opt out of chemotherapy or radiotherapy under
the coercion of avaricious family members. No course of action is
foolproof. The potential abuse is not a good enough reason for us to
reject the suggestion. A more practical approach would be to take the
necessary precautions to avert these eventualities.
Life, My Choice
The right to die can be traced to the old common law notion of
self-determination, or autonomy. The freedom of choice in an individual is
cherished greatly and in turn leads to the right of privacy
which is constitutionally protected and central to a democratic
system. Society should respect the right of an individual to control his
or her own life. Zones of privacy that society should not intrude upon
without good reason are ‘a person’s body, possessions, beliefs,
values, actions and associations, as long as they are within his private
sphere of interest and conduct’.
Patients have a right to refuse treatment. This is a long
recognised right that physicians are legally and ethically required to
honor. A cancer patient might decide, after much deliberation with his
doctor and family members, that he does not want to go through with the
painful procedure of chemotherapy just to delay death for a few years.
He might prefer a shorter life with more purpose to one where he
loses his bodily autonomy and control to medical treatment. The doctor
gives the green light. But when the doctor turns around and faces a
terminally ill patient who seeks his assistance in releasing him from the
unendurable suffering in his final days, he says no. Why should the
patient’s right of control over his body be suspended precisely when
death is imminent? What real
freedom of choice does a patient have when he cannot even control this
crucial phase of his existence?
I am not proposing that personal autonomy is an absolute right.
Yes, the state does have an interest in preserving life and if it wants to
limit autonomy, it should give a good reason. This might come in useful in
the case of a handicapped where he might have been coerced into making his
decision. However when we are dealing with a competent person, who, after
a reflective decision, has opted for voluntary active euthanasia, the
state has no right to interfere with such a personal decision where life
is at stake. Who better to decide than the person suffering the
autonomy however, is not a convenient licence for people to commit
suicide. This has to be balanced by the need to serve human dignity.
Compare these two scenarios: a girl slits her wrists after her boyfriend
ditched her; a terminally ill woman takes a lethal dose of barbiturates
when she loses her entitlement to a meaningful existence. Surely the
latter does not deserve the same moral censure as the former.
of life v quality of life
the human worth? Is life so intrinsically valuable that its
self-destruction is an act of murder and therefore wrong? Opponents of
euthanasia subscribe to the notion of the ‘sanctity of life’ because
human beings are special, even unique, and being alive is of infinite
value and can never be trumped by any amount of suffering. Coming from a
religious angle, they also argue that it is a gift of God and since
‘only God can give life, then only God may end it’.
Hume’s rebuttal to that lies in the free will bestowed by God upon
mankind, which should include freedom to take one’s own life, especially
when life has become intolerable.
about the quality of life? What happened to leading a meaningful life?
Advocates of euthanasia believe that if the quality of life is compromised
due to debilitating illness or great despair, then life no longer has any
worth. We believe in the inherent importance of one’s life to the extent
that one has to make his life a good and meaningful one while it lasts. We
do not, however, believe in this absolute intrinsic value of life such
that it should be preserved at all costs.
Look at the technologically resplendent world today, a place
that our predecessors would never have dreamt of a hundred years ago.
Doctors can now cure “incurable” diseases and undoubtedly, society has
benefited from this advancement. People live longer, and healthier lives.
On the downside, the wonders of medical progress have proven to be a bane
to those who wish to die a natural death. There are those who have no wish
to be kept alive in terminal illness or a comatose state for long periods
of time, those who see this desperate prolongation of life as dehumanizing
What is the worth in just keeping the bodies that these
patients once inhabited technically alive?
do the physicians stand?
The talk about the physician-assisted deaths usually starts with
Dr. Jack Kevorkian’s activities, in assisting more than 130 people to
end their lives. He also aired the controversial homemade videotape of Mr
Youk’s death on the CBS television programme 60 minutes in November
1998. Mr Youk, 52, suffered from Lou Gehrig’s disease and wanted to die
on his own terms before the illness so progressed that he would choke to
death. Murderer? Benevolent Saviour? Call him any name you want, but
families of the deceased definitely feel that Kevorkian did not deserve
the 10 to 25-year sentence he is serving now.
case forces us to face up to the fact that many people are suffering
needlessly and if they so desired, they ought to be allowed to die with
the help of a doctor. It also forces us to examine whether the
legalization of physician-assisted deaths would really undermine a
physician’s professional ethics.
Doctors are sworn to protect life, but far more than most people in
society, they see death. They see people so diseased and wrecked with pain
that death is preferable to life. The archaic Hippocratic Oath prohibits
doctors from the giving of ‘deadly medicine’ to anyone who asks.
Fortunately, science and technology have come a long way from the time of
the Hippocratic Oath when doctors had very limited resources to work with.
Unfortunately, rules governing the medical practice are lagging far behind
compared to the pace of advancing technology in the new century.
It is hard to deny in
a secular world that suffering and illness are necessarily bad in
themselves and thus any attempt to alleviate the burden is always
justifiable. In some cases, the cure can be worse than the disease itself.
We should not be quick to condemn the doctor who hastens death upon the
voluntary request by the patient - to do what is in the best interest of
might say that palliative care should be the right approach in dealing
with patients in excruciating pain, assuming that it is pain that drives
terminally ill people to resort to death. We are then faced with the
uncomfortable principle of “double effect” of palliative care.
Consider this. Doctors are allowed to administer heavy doses of morphine
to relieve the patient’s immeasurable pain, with full knowledge that
there is a risk that this might kill the patient. The patient dies. The
doctor then conveniently indicates on the patient’s death certificate
that he died from ‘natural causes’. This is condoned, since the doctor
had not intended to kill. On the other hand, if the doctor performs the
very same act with the primary aim to hasten death while the secondary
effect is the relief of pain, it is morally abhorrent.
present state of law, doctors find themselves in a strange situation where
honesty with regards to the purpose of their administration of drugs is
the very way that will expose them to prosecution. The guideline thus
evolved: ‘Practice euthanasia covertly, and you will be alright’.
When a patient (or his lawful surrogate) decides to pull the plug
or makes a final request for a lethal dosage of drugs, it should not be
dismissed merely as a cowardly way out.
Pain is not the sole reason for a decision of such finality. The
loss of control and the degradation of the quality of life are the main
of euthanasia on the moral high ground refuse to look at the facts as they
are. They refuse to acknowledge the widespread practice of
physician-assisted deaths under the guise of palliative care. They cannot
even imagine why such a deteriorated existence is not worth living.
Legalisation of both active and passive voluntary euthanasia is
necessary for us to give effect to the patient’s right to choose. No
solution is infallible. It is more important for us to identify the
dangers and provide the necessary safeguards. One such measure would be
the legalisation of euthanasia only under very restricted conditions. This
addresses the opponents’ fear of the society degenerating into one that
sanctions the killing of the old, disabled and anyone who becomes a burden
give certainty to the medical practice where physicians can carry out
their duties safely, free from fear of prosecution. Let us have some faith
in mankind and the values that prevail in our society. Let us not deprive
the patient’s right to die with dignity.
on my bed with a tube inserted into my arm, I place my finger over the
button that I would press in a moment to start the flow of solution that
would finally release me from my agony and put me into a deep sleep. I pan
the room to have a final look at the faces of all my loved ones, and I
pause at the face of one man- the doctor who has shown me the ultimate act
of mercy and kindness. Thank you.
1. “Lethal Judgments: Assisted Suicide and American Law”; Melvin I Urofsky; Lawrence, Kan; University Press of Kansas, 2000
2. “Dying With Dignity: Understanding Euthanasia”; Derek Humphry; Secaucus, N.J; Carol Publishing Group, 1992
“The Right to Die : A
Two-volume Anthology of Scholarly Articles”; Series Editors: Melvin I.
Urofsky, Philip E. Urofsky; New
York : Garland Pub. , 1996.
4. “The Right to Die : Understanding Euthanasia”; Derek Humphry, Ann Wickett; London : Bodley Head , 1986.
Urofsky, Melvin I. “Lethal Judgments” University Press of Kansas,
This interesting illustration is provided by Graham Oddie in his bare
difference argument in the article “The moral case for the
legalisation of voluntary euthanasia” Victoria University of
Wellington Law Review28 (1998) 207-224
In re Quinlan 355 A.2d 647 (N.J. 1976)
Cruzan v. Director, Missouri Department of Health 497 U.S. 261
For a fuller discussion of the right to privacy, you can refer to Paul
Kurtz, “Forbidden Fruit: The Ethics of Humanism” pp.63-96 (1988)
This is qualified by Richard Momeyer, an advocate of suicide who does
not see suicide as an unlimited right.
Supra n.1, p. 3
David Hume reasons that suicide is not always wrong in his essay “On
Thomas Preston, a cardiologist at the University of Washington,
condemns morphine drips as just another name for euthanasia.
|Any comments or questions regarding this essay can be addressed to: Radhika Prabhakar|
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