Lecture 6: Euthanasia and Physician-Assisted Suicide DR.

Elizabeth Luvai

Introduction

No one escapes death—or the ethical issues that come with it.

Advances in medicine now raise the old life-and-death questions anew, force new ones more unsettling,
and provoke answers that are disturbing even when plausible.

In euthanasia and physician-assisted suicide, the bioethical heart of the matter is the moral rightness of
killing or letting die for the good of the patient.

The countless disputes on this terrain are often fierce and elemental, for they are the visible signs of
deep conflicts among fundamental moral principles and perspective

Reasons for request

For those sound of mind: loss of autonomy,

Decreasing ability to participate in enjoyable activates,

Loss of dignity were cited by 76-96% of patients

Definitions:

Passive euthanasia is simply allowing the person to die, either by withholding treatment or by
discontinuing such treatment, once begun.

Active euthanasia, on the other hand, is taking some positive step to terminate life, such as the
administration of a toxic substance or the injection of an air bubble into the blood stream.

Euthanasia may also be classified as either voluntary, where the subject himself expresses his desire
for his life to end, or involuntary, in cases where he has not indicated such a choice.

Kinds of euthanasia that have been the main focus in bioethics:

1. Active voluntary—Directly causing death (mercy killing) with the consent of the patient

2. Active nonvoluntary—Directly causing death (mercy killing) without the consent of the patient

3. Passive voluntary—Withholding or withdrawing life-sustaining measures with the consent of the

4. Passive nonvoluntary—Withholding or withdrawing life-sustaining measures without the consent of

The Value of Human Life

 Three Conceptions:

Sanctity of Life

Inviolability of Life

Worthwhileness of Life

Sanctity of Life

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Lecture 6: Euthanasia and Physician-Assisted Suicide DR. Elizabeth Luvai

 Value of human life is absolute.

 Life has to be preserved at all cost.

 Advocates in general would say “no” to death penalty, suicide, abortion, euthanasia, and
warfare (pacificism).

 It is difficult to ascertain the intention of an action and the distinction between intended and
foreseen consequences is unclear.

Inviolability of Life

 Human life is a basic good, not an absolute good.

 The value of human life only implies its inviolability which prohibits the intentional killing of an
innocent.

 The English law adopts the inviolability principle.

 This principle embraces the doctrine of double effect.

 According to this doctrine, the inviolability principle is not violated by an action which has the
foreseeable consequence of shortening a life if:

-the action is performed out of necessity for a good end,

-the shortening of life is not a means but only a side effect of the action, and

-the shortening is merely foreseen but unintended.

 The doctrine has a wide range of applications.

 The inviolability principle does not require preserving life at all costs.

 Forgoing Life Sustaining Treatment that is burdensome/futile is not an act of passive euthanasia
because it is not performed with an intention to shorten the life of a patient. It only aims to
promote his/her best interests and the shortening is merely a side effect. Labeling it as ‘passive
euthanasia’ can create a lot of confusions

Worthwhileness of Life

 The value of a human life depends on whether it is worth while.

 Not every life is worth living. Some patients would be better off dead and so it is morally right to
end their lives intentionally.

 Voluntary active euthanasia (VAE) is morally justified because it relieves them from unbearable
and hopeless suffering.

 Objections:

The justification stems from the judgment that the patient’s life is not worth living. It doesn’t really
matter whether the request is voluntary. So why not non-voluntary or even involuntary euthanasia for
incompetent patients in the same condition?

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Lecture 6: Euthanasia and Physician-Assisted Suicide DR. Elizabeth Luvai

Discrimination – Why is the deprivation of life morally permissible just for this group of patients but not
others?

 Replies to Objections:

There is no discrimination if these patients choose to die voluntarily.

On the contrary, not allowing them to die is discriminatory because their special conditions have not
been duly considered

Some schools of thought:

1. active and passive euthanasia are not morally significant

2. active is wrong, passive OK

3. both active and passive euthanasia are different than the cessation of extraordinary means of
treatment to prolong life

4. doctors cannot be an agent of harm

5. some people have a duty to die

Philosophical issues

 Euthanasia is contrary to medical professional standards

Two situations

There are at least two situations where cessation is not the same as passive euthanasia:

the right to refuse treatment and when continued treatment brings more discomfort and has little
chance of survival

Patient’s right

In general, a competent adult has the right to refuse treatment, even when the treatment is necessary
to prolong life

 It may be overridden [if you have a dependent child]

Continued treatment and pain

When continued treatment has little chance of improving the patients condition, and brings greater
comfort than relief termination of treatment does not “bring about the death of a patient”

 To continue would be “extraordinary”

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Lecture 6: Euthanasia and Physician-Assisted Suicide DR. Elizabeth Luvai

 The term means different things in different situation

Children, minors and euthanasia

Relegating pediatric assisted suicide and euthanasia to the margins is reassuring. The intentional killing
of children and adolescents, or assistance in their suicides, is surely more disquieting than the same
practices among competent adult patients.

Two situations where it might be moral

A child is suffering terribly from incurable cancer, and both he and his parents request a lethal injection
of drugs to put an end to his pain.

 A newborn with defects that cause severe, chronic pain is asked to be given an overdose of
pain medication.

The Law

As of 2002 euthanasia for children aged 12 to 16 is legal in the Netherlands when the child's parents
agree to his or her request.

 Minors aged 16 or 17 can legally request and receive euthanasia based on their decision alone,
although the child's parents must be informed of that decision.
 Both active assisted-suicide (giving of a medicine) to cause death of a patient as well as passive
assisted-suicide (withdrawal of treatment, including artificial feeding and hydration) are
prohibited under Kenyan law. Further, the law does not recognize agreements between
individuals that may lead to death. This discovered under section 209 of the Penal Code

Some ethical concerns

End-of-life decisions made by children may be too easily colored by the concerns of those around
them.

🞇 Hypothetical situations do not determine real- life actions

🞇 Neurological or psychological issues mean children cannot be expected to make these decisions for
themselves

Yet is should be remembered that:

minors may be more vulnerable to euthanasia and more apt to request assisted suicide because of
inferior pain relief,

the large numbers who are poor,

the substantial number who are uninsured,

the complex dynamics of parental decision making for ill or disabled minors,

and psychological differences between adults and those who are younger.

Other last resort options

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Lecture 6: Euthanasia and Physician-Assisted Suicide DR. Elizabeth Luvai

 Sedation to unconsciousness
 Pain and symptom management
 Right to forgo lifesaving treatment
 Voluntarily stopping eating and drinking [VSED]
 Sedation to unconsciousness

Utilitarian's view on euthanasia

Utilitarians can consistently adopt different views on active euthanasia and assisted suicide depending
on how they define the good to be maximized, whether their moral focus is acts or rules, and how much
importance they give to self-determination.

Classic utilitarianism defines the good as happiness and would therefore judge the issues by how much
happiness various actions might produce for everyone involved.

Rule-utilitarian approaches can lead to positions both favoring and opposing euthanasia and assisted
suicide.

Most slippery-slope arguments are essentially rule-utilitarian, asserting that a general policy of
authorized killing will, step by step, take society down a path to awful consequences.

The outcomes to be avoided are many, including increases in non-voluntary or involuntary euthanasia,
erosion of respect for the medical profession, and a weakening of society’s abhorrence of homicide.

Some also argue on rule-utilitarian grounds for a general policy, citing relief of suffering as the most
obvious benefit

Kantian theory

What is clear in Kant’s theory is that suicide is prohibited because it treats persons as mere things and
obliterates personhood.

Kant asserts that “the rule of morality does not admit of [suicide] under any condition because it
degrades human nature below the level of animal nature and so destroys it.”

It is also apparent on Kant’s view that competent persons must not be killed or permitted to die

But it is not obvious what Kant’s opinion would be of individuals no longer regarded as persons because
they have lapsed into a persistent vegetative state.

Would respect for persons demand that they be kept alive at all costs—or that we perform non-
voluntary euthanasia to allow them to die with dignity?

Further reading

Millard J. Erickson and Ines E. Bowers, “EUTHANASIA AND CHRISTIAN ETHICS” JOURNAL OF THE
JOURNAL OF THE EVANGELICAL THEOLOGICAL SOCIETY 15-24: 15-19, 22.

The State of the Law on Euthanasia in Kenya. Available from:

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Lecture 6: Euthanasia and Physician-Assisted Suicide DR. Elizabeth Luvai

Gerald Dworkin, “Physician-Assisted Death: The State of the Debate,” in The Oxford Handbook of
Bioethics, ed. Bonnie Steinbock (Oxford: Oxford University Press, 2007), 375–92.

Gerald Dworkin, R. Frey, and S. Bok, Euthanasia and Physician-Assisted Suicide (Cambridge: Cambridge
University Press, 1998).

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