EUTHANASIA

Euthanasia is the intentional taking of a person's life from a beneficent or kind motive–typically in a case of grave and terminal illness. Increasingly, however, the term is also used of cases in which a person, though gravely ill, is not immediately threatened with death. She simply does not want to live out the life to which illness has condemned her.

Three distinctions figure prominently in discussions of euthanasia: the distinction between active and passive euthanasia; the distinction among voluntary, involuntary, and non-voluntary forms; and the distinction between physician-assisted suicide and euthanasia.

Active and Passive Euthanasia

Active euthanasia involves taking steps to terminate a life. Passive euthanasia involves omitting steps to save a life or withdrawing treatment. At present, active euthanasia is frowned upon by law and the medical profession, whereas passive euthanasia–for example, withdrawing a ventilator that keeps alive a patient whose further care is deemed futile–is not.

The question of whether one can sustain a distinction between active and passive euthanasia is hotly debated. A person will die if injected with a large enough dose of morphine, which may be given in the guise of pain relief, but he will also die if feeding tubes are removed. In a patient whose further care is deemed futile, what is the moral difference between these two ways of producing death?

Voluntary, Involuntary, and Non-Voluntary Euthanasia

A distinction may be drawn among voluntary, involuntary, and non-voluntary euthanasia. In voluntary euthanasia, the steps taken to end life are taken with the patient's consent, and often at her instruction.

In involuntary euthanasia, the steps taken are without the consent of the patient, and without his request; in fact, euthanasia may be something to which he explicitly would not consent.

Non-voluntary euthanasia typically refers to taking steps to end the life of someone deemed incompetent by medical and legal authorities. The steps are taken at the consent of a trustee whom the person has designated to represent her interests. This can prove problematic if the patient has no designated trustee empowered to consent. It is possible that, if a trustee is then appointed to represent a patient's interests and consents to euthanasia on her behalf, the case has been transformed into one of involuntary euthanasia.

Physician-Assisted Suicide and Euthanasia

A distinction is usually drawn today between physician-assisted suicide and euthanasia. One useful way of marking this distinction is to say that, in the former, the last causal actor is the patient, whereas in the latter it is the doctor.

A doctor supplies a terminally ill patient who is competent, who is not suffering unduly from depression, and who voluntarily requests assistance in dying with a pill that will prove lethal. If the patient takes the pill and swallows it, the doctor does not produce the patient's death; the patient does so through accepting the pill and deciding to swallow it. The pill produces death only if it is swallowed, and the doctor does not force it down the patient's throat; rather, the patient voluntarily swallows it.

Euthanasia, Quality of Life, and Aging

The morality of so-called "mercy killing" has had a long history. This is inevitable, for there are two central facts about the human condition that dominate moral consideration of the topic.

First, the quality of human life can deteriorate massively, so that someone may remain alive, but in effect can come to have "no life." The objection is sometimes made that no one is entitled to say that someone else's life is not a life worth living; but it is possible to say this of those in permanently vegetative states or of anencephalic infants, who live lives that no one would wish for anyone. Indeed, the whole topic of physician-assisted suicide has arisen precisely because many of those condemned to live out lives blighted by amyotrophic lateral sclerosis and the like state that they do not wish to do so. If they are regarded as having a right to refuse treatment, then they do not have to live out their lives. But if they are not so regarded, or if they are no longer competent to insist upon this right, or if they have no advanced directive that is honored by authorities, then they are forced to continue to live.

Second, improved living conditions, increased prosperity, better health care, and technological innovation have increased human longevity dramatically. A larger elderly population has made nursing homes more important, has made geriatrics into a major medical science, and has focused attention upon the lives–and deaths–of elderly men and women. As they come to face death, especially as they come to face death in the context of lives plagued by illness and degenerative disease, the moral and social aspects of suicide, assisted death, and euthanasia inevitably become topics of debate. This is particularly true of moral implications as societies come to give greater weight to individual autonomy and to permit individuals a say in their own treatment and the ending of their lives.

Euthanasia and the Law

Relaxation of prohibitions against physician-assisted suicide and active voluntary euthanasia were frequently urged at the turn of the twenty-first century, and Oregon, the Netherlands, and the Northern Territory of Australia took some steps toward relaxation (since put on hold in the Australian case in the late 1990s). Preliminary data from both Oregon and the Netherlands suggest that neither physician-assisted suicide nor active voluntary euthanasia is yet used by a significant part of the elderly as a preferred option of ending lives. In 1998 in Oregon only 15 deaths were reported under the new law there, and the update of data in the Netherlands in 1995 found that vastly more patients chose to forego treatment than to take advantage of the suicide law. The option continues to exist, however.

The Morality of Euthanasia

Whatever the specific objections to relaxation of prohibitions on physician-assisted suicide and active voluntary euthanasia may be, opponents have fostered fear of a "slippery slope" as one of the lurking dangers of such a course. This means a fear that voluntary euthanasia shall soon pass to involuntary euthanasia; that competent patients requesting death shall soon pass to incompetent persons who have no idea what they are requesting (or for whom euthanasia is requested by someone else); that letting physicians prescribe pills for competent patients who voluntarily request assistance in dying shall soon pass to physicians killing off patients in all kinds of situation, for all sorts of nefarious reasons; that assisted death and euthanasia as socially approved options shall soon pass to circumstances in which patients feel pressured for various reasons to choose one of these options, even when they would otherwise want to prolong their lives.

Opponents of change almost always urge slippery-slope objections not only against social changes but against even thinking about changes, and this has long been the case with active voluntary euthanasia. In fact, good evidence is needed to believe such claims. However, for many opponents of active voluntary euthanasia, slippery-slope concerns are at bottom not the main argument. In circumstances where it was clear that slippery-slope effects were exceedingly unlikely to arise, few opponents to active voluntary euthanasia would remove their objections.

Most religions continue to insist that life is a gift from God that can only be justly taken by God. To many adherents it follows that quality of life concerns are not centrally germane to the whole issue of the prolongation of life. Advocates believe the fact that physician-assisted suicide and active voluntary euthanasia give voice to the value of autonomy, to the demands of patients to have a say in their own treatment, and to the wish of many to be able to decide not only how they will live but also how they will die, is unlikely to carry the day as a moral argument.

See also: Religions, Population Doctrines of; Reproductive Technologies: Ethical Issues.

bibliography

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R. G. Frey