Is Euthanasia Morally Permissible?

By: William Griffiths, MSc Philosophy 2015, University of Edinburgh

In this essay I argue that there is a strong moral case for the permissibility of euthanasia. In order to argue this, I first make some necessary distinctions for my discussion. Second, I present my argument for euthanasia which consists of respecting a person’s wishes and acknowledging that person’s suffering. My argument builds on the permissibility of suicide to argue that euthanasia is, in some circumstances, permissible. Third, I consider possible objections to my argument. The objections being that suicide is irrational, that a person who is suffering considerable pain cannot make a competent request to die, and that, while passive euthanasia might be permissible, active euthanasia is not, because it consists of killing a person. I argue that none of these objections are successful and that there is a case for the permissibility of euthanasia. This essay focuses solely on the moral case for euthanasia. Although there is a large amount to say on “slippery slope” arguments and arguments concerning the medical profession’s integrity, I take these to be legal objections to euthanasia, and I will not consider them here.

Euthanasia will be defined as allowing a person to die or intentionally killing a person who, it is believed, would be better off dead. Two distinctions will help me make my case for euthanasia. First, euthanasia is commonly divided into passive and active euthanasia. Passive euthanasia is allowing a person to die and active euthanasia is intentionally killing a person. The essay will present an argument under which both forms are morally permissible. Second, euthanasia is often separated into voluntary, non-voluntary and involuntary euthanasia. Euthanasia is voluntary when it is requested by the patient, non-voluntary when the patient is unable to consent and involuntary when the patient who undergoes the euthanasia wishes to carry on living. This essay will address only voluntary euthanasia.

The moral case for the permissibility of euthanasia is underpinned by acknowledging a person’s suffering and respecting that person’s wishes. First, if a person is, as a result of an illness, suffering considerable pain, that person’s existence might not be in his or her best interest. In such circumstances, suicide would be a rational course of action. Second, provided that person has no overriding obligation to others and that person’s death would not cause undue distress to those closest to him or her, suicide would not be morally wrong. Third, if a person has a rational desire to end his or her own life, but is unable to do so unaided, he or she may request that another person assists him or her to die. It would be morally permissible to aid someone to die provided his or her request for suicide was rational, competent and did not cause undue distress to those closest to him or her. Fourthly, if a person makes a competent request for assisted suicide, but is unable to commit suicide, he or she may ask to have any medical treatment he or she is undergoing ended, even if this means he or she will die. Provided the request is rational and competent, allowing a person to die would be morally permissible. Finally, there may be circumstances in which ending the life of a person who cannot commit suicide is preferable to allowing him or her to die. My argument is inspired by that of Tooley (1995, 2003); I have added premise four, because I believe it highlights the transition from assisted suicide to euthanasia more clearly. I believe the progression from suicide, assisted suicide, to passive then active euthanasia makes no unacceptable assumptions and is an appropriate one. I now consider possible objections to my argument.

First, it may be objected that suicide cannot be a rational action. Such an objection could draw on Nagel’s arguments that death is an evil because it deprives a person of life. Even if the bad elements of life outweigh the good elements, life has great value beyond its content; the bare experience of life itself is valuable (Nagel, 1986). Building on Nagel’s argument the objection could say that it is irrational to deprive oneself of something positive. Suicide deprives a person of the positive experience of living. Death, in as much as it is deprivation of life, is negative. Consequently, suicide cannot be a rational action.

However, I cannot see why a life of constant suffering is thought positive solely on the basis of experiencing life. For example, a person being tortured to death would be unlikely to consider the continuation of life a benefit to them. They would more likely see death as a relief. If rationality consists of making choices concerning reasons to act, and acting upon those reasons, it is rational to deprive oneself of a life no longer worth living. I acknowledge that suicide is not necessarily rational; it may, for instance, spring from mistaken beliefs or misplaced anxiety. That does not imply, however, that all suicides are a consequence of an irrational desire to die; some arise from a rational consideration that one’s life consists of intolerable pain. I suspect that this debate reaches an impasse between those who believe life has an intrinsic value in itself and those who believe a person’s pain and suffering can make that life not worth living. The debate is mired in religious considerations (Tooley, 1995, pp. 307-8). The intractable nature of the arguments on either side are such that I do not hope to resolve them here. Nevertheless, I believe that my arguments concerning a person’s life being unbearable to him or her, show that suicide can be a rational action.

Second, it might be objected that even though suicide is rational in some circumstances, the transition to assisted suicide is not acceptable. A person suffering from severe pain, or in a delirium of pain-relief may hardly be able to make a well-informed decision concerning his or her own death (Kamisar, 1958, pp. 985-6). A request to die does not necessarily imply a desire to die. In addition, considering my acceptance that some suicides are performed on the mistaken grounds, how can we ensure requests for assisted suicide are not mistaken?

However, accepting that some people may not be of sufficiently sound mind to make a competent request for assisted suicide does not imply that no one is ever in such a position. If the objection consists in a belief that no one can ever make an informed decision about the value of their life that must be rejected as unacceptably paternalistic (Young, 2014). Competency tests, of the type commonly used by physicians, may help to ascertain whether a decision-maker is of sound mind. I acknowledge my reservations regarding the use of “living wills”, because a person’s desire for death at one time does not necessarily imply their desire to die at a later time (Hawkins, 2014). Nevertheless, the above objections fail to show that no suicide can be rational or that no one can make a competent request to die; they merely highlight difficulties in distinguishing cases. These are not moral problems but problems of classification.

Thus far I have been discussing the permissibility of suicide and assisted suicide; building on the arguments already advanced I now move to the permissibility of passive euthanasia. It has been shown that a person can make a rational and competent request to die. In such circumstances it is permissible to assist a person to commit suicide. For instance, a physician may provide the patient with a lethal injection that he or she can administer to him- or herself. It is an unfortunate fact, however, that some diseases prevent people from committing suicide themselves. Imagine a patient suffering from motor neuron disease; he is attached to a respirator which he needs to stay alive. He is in considerable pain, but is unable to commit suicide. I believe it is morally permissible to remove him from the respirator and allow him to die. I cannot see how passive euthanasia is any less permissible than assisted suicide in this instance. This illustrates my argument’s transition from assisted suicide to passive euthanasia

Third, granting that passive euthanasia is permissible in the circumstances described, it might nonetheless be objected that this is not the case with active euthanasia. The underpinnings of such an objection are that passive euthanasia may be permissible because it involves allowing a person to die, whereas active euthanasia is not permissible, because it involves actively killing a person. Such an objection hinges on the belief that killing is morally worse than letting die.

However, I am not convinced that killing is necessarily morally worse than letting die. Firstly, the distinction between killing and letting die is unclear. For example, consider the man dependent on a respirator to live; the physician carries out man’s competent request by removing him from the respirator and the man dies. Ostensibly, this is passive euthanasia, because the physician lets the man die. Imagine a parallel story in which the man has a son, who desiring only to inherit his father’s fortune, sneaks into his father’s room and removes him from the respirator resulting in death (Brock, 1992, p. 13). As Brock argues, it is natural to think that the son killed his father in such cases; for the son to claim that he merely let his father die would be rejected as sheer sophistry (Brock, 1992, p. 13). Note that the physician and the son have performed precisely the same action Thus it is not clear that we can draw a line between killing a person and letting him die.

It is possible to counter this by arguing that the difference lies not the physician and son’s actions, but the intention behind their actions. According to such a view the physician intended to follow the man’s instructions, while the son intended to kill his father prior to instruction. This makes a moral difference. The physician foresaw, but did not intend, the man’s death. Similarly, if I have a drink to ease my nerves and I foresee a likely hangover tomorrow, it does not mean I intend to have a hangover (Kamm, 1997). Nevertheless, it is not clear that the physician does not intend the man’s death. In extubating the patient, what other outcome did she anticipate than the man dying? The case shows that the distinction between killing and letting die, and thus how to understand active and passive euthanasia, is ambiguous. There is no perceptible difference in action, but there may be in intention.

Secondly, if it is plausible to accept the distinction between killing and letting die on the basis of intentions, what is it that makes the intention to kill worse than the intention to let die? Killing might be considered wrong because it harms the person by depriving them of life. It is worse to actively harm a person than to allow harm to happen (Foot, 2002, p. 80). While this might be true, it does not apply to euthanasia; a genuine case of voluntary and rationally chosen euthanasia does not harm the person, but benefits the person. If actively harming someone is worse than allowing a harm to happen, parallel reasoning would lead us to believe that it is better to actively benefit someone than to allow a benefit to happen; this implies that killing is morally better than letting die (Boonin, 2000, pp. 160-1). This conclusion might seem bizarre, but I will illustrate why there is reason to accept it. If someone is suffering from a chronic, slow and painful illness, and the doctor estimates the patient only has days left to live in severe pain, then I cannot see how letting him die is better than killing him (Rachels, 1977). Killing is better than letting die when a person, who competently and rationally requests death, is in intolerable pain that will impair the quality of the remainder of his or her life.

Considering my arguments thus far, it might be objected that the physician killing the patient involves something that suicide, assisted suicide and passive euthanasia do not. I acknowledge that the physician brings his or her own agency and moral considerations to the table. Observe, however, that the physician is brought into my argument at the second stage. If we reject active euthanasia on the grounds that it involves placing a demand on the physician, we must consider that assisted suicide and passive euthanasia also place a demand on the physician, who must aid a person to die or withhold medication. According to my argument, passive euthanasia may be considered the worse of the options presented, because it involves the slow death of a person. Assisted suicide and active euthanasia end the person’s life without allowing any more pain, the only difference is who administers the fatal dose. In both cases the physician plays a necessary and causal role in the patient’s death, and in both cases the decision is wholly that of the patient (Brock, 1992, p. 10). Assisted suicide and active euthanasia are only problematic if we believe that killing is never permissible, but I demonstrated in earlier examples that killing is permissible in some circumstances. Legally no one can consent to be killed (Young, 2014). Regardless of legal doctrine, killing in this specific context is permissible if the suffering patient made a competent, rational request to die and benefits from death.

In this essay I have argued that there is a strong moral case for the permissibility of euthanasia. Although there are cases in which suicide is irrational and when a person cannot competently request death, this does not show that no one could ever be in such a position. Granting that a person may have a rational wish to die and competently request death, I do not see why that person’s inability to perform suicide should exclude them from a death they believe to be beneficial.  This led me to conclude that passive euthanasia is morally permissible. I then have argued that active euthanasia is also morally permissible, by demonstrating the ambiguities in the distinction between killing and letting die. Some supposed cases of passive euthanasia are really those of active euthanasia. Even when it is possible to distinguish the two, active euthanasia can be morally better than passive euthanasia. The emphasis I placed upon consent and competence might lead some to believe I have been too cautious. However, such caution is a necessary to assuage fears that euthanasia is open to abuse. I would contend that caution strengthens my argument by refusing to descend a “slippery slope” into non-voluntary euthanasia, whereby a person does not consent to death at the time of euthanasia. I argue that there are cases in which a person genuinely has a rational desire to die and the ability to competently request help to die, and are therefore morally justified in committing suicide or seeking assistance to die. Thus, I conclude that there is a strong case for the moral permissibility of euthanasia.

Bibliography:

Boonin, D., (2000), ‘How to Argue Against Active Euthanasia’, Journal of Applied Philosophy, 17/2, 157-68.

Brock, D., (1992), ‘Voluntary Active Euthanasia’, Hastings Center Report, 22/2, 10-22.

Foot, Philippa, (2002), Moral Dilemmas and Other Topics in Moral Philosophy, Oxford, Clarendon Press.

Hawkins, Jennifer, (2014), ‘Well-Being, Time, and Dementia’, Ethics, 124/3, 507-542.

Kamisar, Y., (1958), ‘Some Non-Religious Views Against Proposed “Mercy-Killing” Legislation’, Minnesota Law School Review, 42/5, 969-1042.

Kamm, F. M., (1997), ‘A Right to Choose Death?’, Boston Review, 22. Available online: http://bostonreview.net/BR22.3/Kamm.html (last accessed 26.10.2014).

Nagel, Thomas, (1986), ‘Death’, in Peter Singer (ed.), Applied Ethics, Oxford, Oxford University Press, pp. 9-18.

Rachels, James, (1975), ‘Active and Passive Euthanasia’, The New England Journal of Medicine, 292, 78-80.

Tooley, Michael, (1995), ‘Voluntary Euthanasia: Active Versus Passive, and the Question of Consistency’, Revue Internationale de Philosophie, 49/3, 305-22.

Tooley, Michael, (2003), ‘Euthanasia and Assisted Suicide’, in R. G. Frey and Christopher Heath Wellman, A Companion to Applied Ethics, Oxford, Blackwell Publishing, pp. 326-41.

Young, Robert, (2014) ‘Voluntary Euthanasia’, The Stanford Encyclopedia of Philosophy. Available online: http://plato.stanford.edu/entries/euthanasia-voluntary/ (last accessed 09.12.2014).

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