Euthanasia in the Context of Terminal Illness with Irreversible Suffering

● When: Euthanasia may be considered when a person has a terminal illness with an
imminent prognosis of death, causing severe, unmanageable pain or suffering that
cannot be alleviated by other medical means, such as palliative care.
● Why: In these cases, euthanasia provides a compassionate way to end suffering and
allow for a dignified death.

Additional Considerations:

● Euthanasia allows a person to die with dignity and in control of their situation, without
unnecessary medical interventions.
● The argument is made that the state should not interfere with an individual’s right to die,
as death is a personal matter.
● Keeping individuals alive when there is no cure can be expensive, and euthanasia may
free up resources to treat those who could recover.

Legal Aspects of Euthanasia and Assisted Suicide

● Both euthanasia and assisted suicide are illegal under English law.
● Assisted suicide is illegal under the terms of the Suicide Act (1961) and is punishable by
up to 14 years' imprisonment. Trying to kill yourself is not a criminal act.
● Depending on the circumstances, euthanasia is regarded as either manslaughter or
murder. The maximum penalty is life imprisonment.
● In regions where euthanasia and assisted suicide are legal, cases of misuse have been
documented. For example, in Belgium, deaf twins were euthanized after losing their
sight, and a woman was euthanized due to anorexia. Similarly, in the Netherlands, a
woman requested euthanasia because she was going blind and feared being unable to
maintain cleanliness.
● The United Nations has found that the euthanasia law in the Netherlands violates the
Universal Declaration of Human Rights due to risks to the safety and integrity of life.
Concerns were raised about undue pressure to access euthanasia and circumvention of
safeguards.

According to the Law (Criminal Act)

In the Philippines, euthanasia is strictly illegal and considered a criminal act.

● The Revised Penal Code, Article 253, explicitly criminalizes any form of assistance in
committing suicide, whether the suicide is consummated or not.
● This includes actions that aim to end a person’s life, even with their consent.
● Penalties include imprisonment, reflecting the country’s stringent stance on preserving
life.
Proposed Legislation (Para sa atin)

Efforts to legalize euthanasia in the Philippines have faced significant resistance.

● Senator Miriam Defensor Santiago proposed the "Natural Death Act", which sought to
allow terminally ill patients to refuse life-sustaining treatments.
● The act emphasized the right to autonomy in healthcare decisions, specifically in cases
involving terminal illnesses or irreversible unconsciousness.

Although the proposal aimed to provide patients with more control over their end-of-life care, it
was not passed into law, showcasing the country’s prevailing legal and moral conservatism
regarding euthanasia.

Execution of Directives

● Must be signed by the declarer in the presence of two unrelated witnesses and
notarized.

Revocation of Directives

● Can be revoked anytime through verbal or written statements by the declarer.

Legal Clarifications

● The act specifies that withholding or withdrawing life-sustaining treatment does not
equate to suicide or homicide, nor does it affect life insurance policies.

Ethical Concerns in Euthanasia

● Euthanasia contradicts the goals of comfort care, which, according to the World Health
Organization, aims to help patients die naturally without accelerating or delaying death.
● In Canada, most doctors specializing in comfort care (90%) oppose euthanasia.
● Euthanasia can send a harmful message, implying that lives of the elderly or disabled
are less valuable. It may lead to the perception that illness or disability makes life not
worth living, despite many individuals finding meaning under challenging circumstances.
● Healthcare professionals involved in euthanasia often experience emotional and
psychological challenges. For instance, doctors may seek therapy after performing
euthanasia, and nurses sometimes take time off due to the emotional toll.
● Legalizing euthanasia can create a sense of vulnerability among patients, who may feel
pressured to choose euthanasia to avoid burdening their families or society, particularly
in overburdened healthcare systems.

Ensuring Euthanasia is Not Misused or Abused

To ensure euthanasia is ethically practiced, strict safeguards are necessary:

 ● Informed and Voluntary Consent: The patient’s consent must be fully informed,
voluntary, and free from coercion.
● Independent Medical Evaluations: Multiple independent doctors should confirm the
diagnosis, prognosis, and that the patient's condition is terminal and irreversible.
● Regular Checks and Documentation: Regular checks and guidelines should be in
place to maintain ethical standards, and thorough documentation should be kept to
ensure transparency and accountability

Safeguarding Vulnerable Individuals

To protect vulnerable individuals (e.g., the elderly or those with mental health conditions) from
being coerced into euthanasia:

● Psychological Assessments: Psychological assessments are necessary to ensure that

the individual is not suffering from conditions like depression or cognitive decline that
could impair their judgment.
● Independent Evaluations: Multiple evaluations by healthcare professionals ensure the
decision is made autonomously.
● Re-confirmation of Consent: Consent should be re-confirmed multiple times to prevent
coercion and ensure the decision is free from outside influence.

Historical Context of Euthanasia

● The Nazi "euthanasia" program, called Aktion T4, was a campaign during World War II
where the German government systematically murdered people with disabilities. It
started on July 24, 1939, when a disabled baby named Gerhard Kretschmar was killed
with permission from his parents and Adolf Hitler’s office. This case set the stage for
larger-scale killings.
● Soon after, thousands of children with disabilities were taken from their families and
killed, followed by the murder of around 70,000 adults in gas chambers at special
centers. The Nazis claimed these killings were "mercy deaths," but in reality, they were
part of a eugenics policy aimed at "cleansing" society of people considered unfit.
● Unlike modern ideas of euthanasia, which focus on helping terminally ill people die with
dignity, this program was about the state deciding who deserved to live. It was influenced
by earlier beliefs in eugenics and Social Darwinism, which promoted the idea of
"improving" the population by removing those seen as weak or different. This program is
now recognized as a form of genocide.

Medical and Psychological Implications

● Sedation, which is legal, is an alternative used to ease extreme pain. However, sedation
is not permanent, meaning extreme pain can reoccur.
● Requests for euthanasia are often driven by untreated symptoms, fears, or depression.
Patients may harbor exaggerated concerns about future pain or misunderstand the
severity of their condition.
 ● Diagnoses or prognoses could be incorrect, with patients living longer or healthier than
expected. Patients may also not receive adequate care to relieve suffering.

Arguments for Euthanasia and Assisted Suicide

1. Compassion Argument: Allowing people to "die with dignity" is seen as kinder than
forcing them to live with suffering.
2. Autonomy Argument: Every patient has the right to choose when to die.
3. Public Policy Argument: Assisted suicide can be safely regulated by government
legislation.
4. We Need It (Compassion Argument): Supporters of assisted suicide believe that
allowing people to ‘die with dignity’ is kinder than forcing them to continue living with
suffering.
5. We Want It (Autonomy Argument): Some believe that every patient has the right to
choose when to die, thus asserting the importance of personal autonomy.
6. We Can Control It (Public Policy Argument): Proponents believe that assisted suicide
can be safely regulated by government legislation, ensuring safety and oversight.
7. Respect for Autonomy: Recognizes the patient’s fundamental right to make their own
healthcare decisions, particularly in terminal or irreversible conditions.
8. Prevention of Prolonged Suffering: Avoids unnecessary prolongation of life through
artificial means, preserving dignity and reducing suffering.
9. Legal Clarity: Establishes clear guidelines for implementing and revoking directives,
reducing confusion for families and medical professionals.
10. Protection for Healthcare Providers: Offers immunity to medical practitioners acting in
good faith under established directives, shielding them from civil or criminal liability.
11. Patient Comfort: Encourages pain relief measures even when life-sustaining treatments
are withheld or withdrawn.
12. Autonomy and Self-Determination::People have a fundamental right to decide their
fate, including the decision to end their lives. Denying this right infringes on personal
autonomy, especially when continuing life means prolonged suffering.
13. Relief from Suffering: For patients experiencing immense pain and incurable
conditions, euthanasia provides a compassionate alternative, allowing them to avoid
needless suffering that surpasses the capabilities of palliative care.
14. Recognition of Passive Euthanasia: The right to refuse life-prolonging treatments,
such as in cases of advanced cancer or reliance on feeding tubes, is legally accepted in
many jurisdictions. This principle can logically extend to active euthanasia for cases
where passive refusal is insufficient to relieve suffering.
15. Encouraging Organ Donation: Mercy killing in terminally ill patients can promote organ
donation, potentially saving multiple lives and giving terminal patients a chance to leave
a legacy of life for others.
16. Dignified Death: As the process of dying is part of life, individuals should have the right
to make it as dignified as possible. For some, this includes the option of ending life on
their terms.
 17. Quality of Life over Quantity: The right to life should entail a right to life with dignity
and quality. Extending a painful existence without hope of recovery diminishes the value
of life itself.

Arguments Against Euthanasia and Assisted Suicide

1. Alternative Treatments: Nearly all pain can be relieved through palliative care and
hospices.
2. Slippery Slope: Voluntary euthanasia could lead to non-voluntary or involuntary
euthanasia, as seen in the Netherlands, where 1,000 patients were killed without request
in 1990.
3. Uncontrollable Practices: Reports from countries where euthanasia is legal reveal that
doctors do not always report assisted suicides.
4. Moral Distress: The assumption that patients should have a right to die imposes on
doctors a duty to kill, restricting their autonomy.
5. Impact on Vulnerable Populations: Vulnerable people may feel pressured to choose
euthanasia to avoid being a burden.
6. Risk of Misuse: Directives may be misinterpreted or misused, leading to premature
withdrawal of life-sustaining treatments.
7. Ethical Concerns: Raises moral issues regarding the withdrawal of treatments,
especially when a patient’s wishes are unclear.
8. Pressure on Vulnerable Populations: Vulnerable groups, such as the elderly or
disabled, could face undue influence to opt for euthanasia.
9. Need for Safeguards: Highlights the necessity of robust protections to ensure that
patients’ true wishes are respected without external pressures.
10. Sanctity of Life: Many argue that life is sacred and that euthanasia undermines
society's respect for it. The act of intentionally ending a life conflicts with the belief in the
inherent value of human existence.
11. Potential for Abuse: Legalizing euthanasia could lead to misuse, such as pressuring
elderly or disabled individuals to choose death to relieve their families of financial or
emotional burdens.
12. Religious and Moral Objections: Many religions forbid euthanasia, citing the belief that
life and death are under divine control. For example, Christianity emphasizes that life is a
gift from God, and only God has the authority to end it. Hinduism and Buddhism highlight
the principle of ahimsa (non-harm) and the law of karma, where suffering is part of a
larger spiritual journey toward liberation
13. Undermining Medical Ethics: Euthanasia could weaken the commitment of healthcare
providers to save lives and discourage investment in research for new treatments or
better palliative care options
14. Economic Concerns: Some fear euthanasia might become a cost-effective solution for
healthcare systems, prioritizing financial savings over comprehensive care for terminally
ill patients
 15. Autonomy and Desperation: Paul Longmore critiques assisted suicide as "fictional
freedom," emphasizing that decisions to end one's life often arise from desperation
rather than true autonomy. This challenges the narrative of personal choice.

Legislative Landscape

While some states like Oregon, Washington, and California have legalized PAS, many others
have explicitly banned it, illustrating a divided stance across the U.S.

Disability Prejudice

1. Bias Against Disability: Fear of dependency and loss of autonomy stems from societal
prejudice that equates dignity with independence. This bias marginalizes people with
disabilities and devalues their lives.
2. Two-Tiered Suicide Intervention: A system that offers suicide intervention to some and
suicide assistance to others creates inequity, often based on health or disability status.

Marginalized Groups

PAS disproportionately threatens the poor, minorities, and those with limited access to
healthcare. These groups could face undue pressure to opt for assisted suicide as a cost-saving
measure.

Healthcare Flaws

1. Misdiagnosis: Terminal illness predictions are often inaccurate, leading to premature

decisions. Cases like Dr. Richard Radtke demonstrate that people can live fulfilling lives
despite initial terminal diagnoses.
2. Exploitation: Legal loopholes and unethical practices, such as administering lethal
drugs without proper oversight, as seen in the Wendy Melcher case, expose risks in the
healthcare system.
3. Neglect of Mental Health: Depression and psychiatric conditions are common among
those seeking PAS, yet mental health evaluations are infrequent.

Economic Incentives

1. Cost-Effectiveness: The $300 cost of PAS medication is far cheaper than long-term
medical care, creating an incentive to steer patients toward PAS over providing
necessary treatments.
2. Pressure on Vulnerable Patients: Elderly individuals may feel compelled to choose
PAS to avoid being a financial or emotional burden on their families, as reflected in rising
percentages of cases citing family burdens as a reason for PAS in Oregon.

Broader Implications
 1. Loss of Trust in Medicine: Legalizing PAS may erode society’s respect for the sanctity
of life and undermine the medical profession’s commitment to preserving life.
2. Impact on Care Standards: The focus on PAS might discourage the development of
better treatments and palliative care options for the terminally ill.

Conclusion

While proponents of PAS argue for dignity and autonomy, opponents highlight the risks of
societal prejudice, economic pressures, and flaws in healthcare systems. The debate
underscores the complexity of balancing individual rights with broader ethical and societal
considerations.

Societal Impacts and Risks

● Legalizing euthanasia could harm healthcare quality, such as reducing comfort care
resources or using euthanasia as a cost-saving measure.
● Studies reveal significant misuse of euthanasia laws. For example, 32% of assisted
deaths in Belgium are carried out without request, and 47% go unreported in the
Flanders region.
● Legalizing euthanasia risks eroding trust in medicine, as patients may doubt whether
doctors prioritize healing over ending lives.

Philosophical and Ethical Perspectives

● "Euthanasia is against the oath that healthcare workers take."

○ "I will use my power to help the sick to the best of my ability and judgment. I will
abstain from harming or wrongdoing. I will not give a fatal draught to anyone if
asked, nor will I suggest such a thing."
● Dignity in Dying advocates argue, “We have no control over how we arrive in the world,
but at the end of life, we should have control over how we leave it.”
● George Pitcher noted that changes in euthanasia laws could have “profound adverse
effects on the social fabric of our society.”

Euthanasia and its Distinction from Killing

Is Euthanasia "Mercy Killing"?

Euthanasia is sometimes referred to as "mercy killing" due to its intent to end suffering,
particularly in cases of terminal illness or unbearable pain. The key difference between
euthanasia and other forms of killing lies in the intention:

● Euthanasia (Mercy Killing):

○ The intention is to end suffering and provide a compassionate, peaceful death.
○ It is typically carried out with the patient’s or their family’s consent and under
medical supervision.
 ○ The goal is to alleviate pain, with death being a side effect of the intended action.
● Killing (Murder or Other Forms of Killing):
○ Killing is done with the intention to cause harm or death, often without the victim’s
consent.
○ It is considered morally and legally wrong, as it violates the rights and dignity of
individuals.
○ The motivation for killing is often driven by malice or revenge, rather than the
intent to relieve suffering.
● Killing: Seen as morally worse in most cases, as it directly involves causing harm.
● Letting Die: Generally less condemned, though some believe there is no significant
moral difference between failing to intervene (e.g., not calling an ambulance) and directly
causing a person’s death.
● Healthcare Context: The withholding of life support, at a patient's request, is an
accepted practice, though some argue it has the same moral weight as causing death.

Doctrine of Double Effect in Euthanasia

The Doctrine of Double Effect justifies certain actions in euthanasia cases:

● Intent: The primary goal of administering drugs is to relieve the patient's pain, not to
cause death.
● Unintended Effect: While the drugs may hasten death, the intent is solely to ease
suffering.
● Proportionality: The action must be proportionate to the situation, ensuring the relief of
pain outweighs the unintended harm (death).

Utilitarianism and Euthanasia

From a utilitarian perspective, euthanasia can be seen as a means to reduce suffering and
maximize happiness:

● Voluntary Euthanasia: Supports the greatest happiness principle, which advocates for
actions that promote happiness and reduce suffering. Voluntary euthanasia alleviates
pain and offers a peaceful, dignified death, benefiting both the individual and their family.
● Resource Allocation: The argument is made that keeping terminally ill patients alive
when they no longer contribute to society may waste resources that could be better used
elsewhere, potentially benefiting others and enhancing overall happiness.

Relevant Questions and Responses

1. How can we ensure legalizing euthanasia won’t lead to abuse of vulnerable

individuals?
Legalization must include safeguards like independent medical evaluations,
psychological assessments, and clear documentation to protect individuals from
coercion.
 2. Is euthanasia contradictory to the medical profession’s ethical obligation to "do
no harm"?
“Do no harm” can be interpreted to include alleviating suffering. In cases of terminal
illness, prolonging life against a patient’s wishes can cause greater harm. Euthanasia,
with consent, may align with the ethical goal of reducing suffering.

Questions for Discussion

1. What evidence supports claims of widespread abuse or societal harm in countries like
the Netherlands, Belgium, or Canada that have legalized euthanasia?
2. How can the economic burden on families and healthcare systems from prolonged
end-of-life care be addressed if euthanasia remains illegal?
3. How do we prevent individuals from seeking unsafe, illegal methods to end their
suffering?
4. How does denying euthanasia respect human rights, particularly the right to die with
dignity?
5. How can non-maleficence (do no harm) be upheld when prolonging life in terminally ill
patients causes unbearable suffering?

references:

● https://www.researchgate.net/publication/7682638_The_complexity_of_nurses'_attitudes
_toward_euthanasia_A_review_of_the_literature)
● https://vivredignite.org/en/against-euthanasia/
● https://care.org.uk/cause/assisted-suicide/arguments-for-and-against-assisted-suicide-an
d-euthanasia
● https://www.nhs.uk/conditions/euthanasia-and-assisted-suicide/
● https://pmc.ncbi.nlm.nih.gov/articles/PMC3070710/#sec8
● https://en.wikipedia.org/wiki/Euthanasia#Nazi_Euthanasia_Program
● BBC Bitesize. (n.d.). Arguments for euthanasia. BBC.
https://www.bbc.co.uk/bitesize/guides/zhbqf4j/revision/8#:~:text=Arguments%20for%20e
uthanasia&text=Euthanasia%20enables%20a%20person%20to,no%20cure%20for%20t
heir%20illness
● BBC Ethics. (n.d.). Doctrine of double effect. BBC.
https://www.bbc.co.uk/ethics/introduction/doubleeffect.shtml#:~:text=This%20is%20know
n%20as%20the%20doctrine%20of%20double%20effect.&text=This%20principle%20is%
20commonly%20referred,may%20shorten%20the%20patient%27s%20life
● Berman. S. J., (2024). What Is Murder? Is Murder Different From Homicide?.
https://www.nolo.com/legal-encyclopedia/homicide-murder-manslaughter-32637.html
● Jamesa. (2016). Utilitarianism View on Euthanasia.
https://sites.dwrl.utexas.edu/liberrimus/2016/10/04/utilitarianism-view-on-euthanasia/
● University of Missouri School of Medicine. (n.d.). Euthanasia. University of Missouri.
https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/euthanasia
● https://legacy.senate.gov.ph/lisdata/34342743!.pdf?form=MG0AV3
● https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-024-01063-7?form=M
G0AV3
● https://www.legalserviceindia.com/legal/article-12500-euthanasia-ethical-considerations-
and-legal-perspectives.html?form=MG0AV3
● https://code-medical-ethics.ama-assn.org/ethics-opinions/euthanasia?form=MG0AV3
● https://www.clearias.com/euthanasia/
● https://byjus.com/free-ias-prep/euthanasia-or-mercy-killing/
● https://theconversation.com/we-have-a-right-to-die-with-dignity-the-medical-profession-h
as-a-duty-to-assist-67574
● https://dredf.org/why-assisted-suicide-must-not-be-legalized/