When is euthanasia morally acceptable

People who oppose euthanasia still believe it's inherently wrong — it can't be morally justified and even compassionate motives don't make it ethically acceptable. But what are the attitudes of pro-euthanasia advocates regarding whether its use needs to be justified, were it to be legalized? And, if justifications are required, what are they? People who would accept euthanasia, but only in some circumstances, usually limit its access to people who are terminally ill, in serious unrelievable pain and suffering, and require that euthanasia be used as a last resort.

These limitations show these people believe each case of euthanasia needs moral justification to be ethically acceptable.

But although the need for euthanasia to relieve pain and suffering is the justification given, and the one the public accepts in supporting its legalization, research shows that dying people request euthanasia far more frequently because of fear of social isolation and of being a burden on others, than pain. So, should avoiding loneliness or being a burden count as a sufficient justification? Recently, some pro-euthanasia advocates have gone further, arguing that respect for people's rights to autonomy and self-determination means competent adults have a right to die at a time of their choosing, and the state has no right to prevent them from doing so.

In other words, if euthanasia were legalized, the state has no right to require a justification for its use by competent, freely consenting adults. For example, they believe an elderly couple, where the husband is seriously ill and the wife healthy, should be allowed to carry out their suicide pact.

In the challenges culminated in the Australian National Parliament overturning the legislation when it prohibited Australian territories from enacting legislation to permit voluntary euthanasia on constitutional grounds. Australia is a federation consisting of six states and two territories. Unlike the territories, the states do have the constitutional right to enact such legislation and in the state of Victoria did just that.

The legislation came into effect in In , a second state, Western Australia, enacted legislation to enable voluntary medically assisted death. The legislation became effective in In three further states, Tasmania, South Australia and Queensland enacted legislation to enable voluntary medically assisted death which will come into force in for the first two, and for the third.

In November , The Netherlands passed legislation to legalize the practice of voluntary euthanasia. The legislation passed through all the parliamentary stages early in The Belgian parliament passed similar legislation in and Luxembourg followed suit in For a very helpful comparative study of relevant legislation see Lewis See also Griffiths, et al. In Oregon in the United States, legislation was introduced in to permit physician-assisted suicide after a referendum strongly endorsed the proposed legislation.

Later in the Supreme Court of the United States ruled that there is no constitutional right to physician-assisted suicide; however, the Court did not preclude individual states from legislating in favor of physician-assisted suicide so the Oregon legislation was unaffected.

Since that time the Oregon legislation has been successfully utilised by a significant number of people and similar legislation has been passed in the state of Washington in , in Vermont in , and more recently still in California, Colorado, Hawaii, Maine, New Jersey, NewMexico and the District of Columbia. A series of judicial decisions in the state of Montana in and established that the state could not prohibit physician-assisted suicide but legislation has not yet been introduced to codify the legal situation.

A number of the remaining states are currently considering physician-assisted suicide bills. A similar legal position to that in Montana has obtained in the nation of Colombia since the late s as a result of a majority ruling by its Constitutional Court in favor of the legality of physician-assisted suicide.

In , Spain legalized voluntary euthanasia. In Austria, Germany and Italy courts have authorised physician-assisted suicide but no legislative backing for the practice has been introduced, while in Portugal there is legislation in place for physician-assisted suicide but it is currently under review for its constitutionality.

In Canada, the province of Quebec introduced legislation permitting medical aid in dying in The legislation came into effect in at around the same time that the Canadian National Parliament passed legislation permitting both physician-assisted suicide and voluntary euthanasia throughout all of the Canadian federation.

For a brief account of events leading up to the enactment of the various pieces of legislation in the United States and in Canada see Sumner New Zealand held a referendum in which resulted in approval for the introduction of legislation for voluntary medically assisted death. The legislation comes into effect late in With that brief sketch of the historical background in place, we will proceed first to consider the conditions that those who have advocated making voluntary medically assisted death legally permissible have typically insisted should be satisfied.

Consideration of the proposed conditions will establish a framework for the moral interrogation that will follow in Sections 3 and 4. Section 3 will outline the positive moral case put forward by those who want voluntary euthanasia and physician-assisted suicide to be legally permissible. Section 4 will be devoted to scrutinising the most important of the objections that have been levelled against that case by those opposed to the legalization of voluntary euthanasia and physician-assisted suicide.

It should be acknowledged that these conditions are quite restrictive, indeed more restrictive than many think appropriate. In particular, the first condition restricts access to voluntary euthanasia to those who are terminally ill. Those who consider that cases like these show the first condition to be too restrictive e. Even so, they believe that voluntary euthanasia should be permitted for those who consider their lives no longer worth living, not just for for the terminally ill. The fifth condition further restricts access to voluntary euthanasia by excluding those capable of ending their own lives, and so may be thought unduly restrictive by those who would wish to discourage terminally ill patients from attempting suicide.

There will be yet others who consider this condition to be too restrictive because competent patients can always refuse nutrition and hydration see, e. Though this is true, many competent dying persons still wish to have access to legalized medically assisted death, rather than having to rely on refusing nutrition and hydration, so that they may retain control over the timing of their deaths and avoid needlessly prolonging the process of dying.

The third condition recognises what many who oppose the legalization of voluntary euthanasia do not, namely, that it is not only a desire to be released from pain that leads people to request help with dying. In The Netherlands, for example, pain has been found to be a less significant reason for requesting assistance with dying than other forms of suffering like frustration over loss of independence see e. Sufferers from some terminal conditions may have their pain relieved but have to endure side effects that, for them, make life unbearable.

Others may not have to cope with pain but, instead, with having to rely on forms of life support that simultaneously rob their lives of quality as with, e. Yet others struggle with psychological distress and various psychiatric conditions and believe these conditions ought to be counted among the forms of suffering that qualify competent individuals to access medical assistance with dying.

There has been greater recognition of, and support for, this position in The Netherlands and Belgium than elsewhere, probably because legislation in those jurisdictions makes the role of unbearable suffering central to the determination of the eligibility of competent individuals for medical assistance with dying. Even so, inclusion of these forms of suffering highlights legitimate issues to do with the competence of at least some of those who suffer from them. For a helpful recent study of the handling of requests for assistance with dying by psychiatric patients in The Netherlands see Kim, et al.

A final preliminary point is that the fourth condition requires that the choice to die not only be uncoerced and competent but that it be enduring. The choice is one that will require time for reflection, and, almost certainly, discussion with others, so should not be settled in a moment.

Nonetheless, as with other decisions affecting matters of importance, adults are presumed to choose voluntarily and to be competent unless the presence of defeating considerations can be established. See the entry on decision-making capacity.

There is no need to deny that this burden can sometimes be met e. Clearly the five conditions set out above are likely to require some refinement if complete agreement is to be reached but there is sufficient agreement for us to proceed without further ado to consideration of the cases for and against legalization of voluntary euthanasia.

One central ethical contention in support of voluntary euthanasia is that respect for persons demands respect for their autonomous choices as long as those choices do not result in harm to others. People have an interest in making important decisions about their lives in accordance with their own conception of how they want to live.

In exercising autonomy, or self-determination, individuals take responsibility for their lives; since dying is a part of life, choices about the manner of their dying and the timing of their death are, for many people, part of what is involved in taking responsibility for their lives. Many are concerned about what the last phase of their lives will be like, not merely because of fears that their dying might involve them in great suffering, but also because of the desire to retain their dignity, and as much control over their lives as possible, during this phase.

A second contention in support of voluntary euthanasia was mentioned at the beginning of this entry, namely the importance of promoting the well-being of persons. When someone is suffering intolerable pain or only has available a life that is unacceptably burdensome see the third condition above , and he competently requests medical assistance with dying, his well-being may best be promoted by affording him that assistance.

When harnessed together, the value to individuals of making autonomous choices, and the value to those individuals who make such choices of promoting their own well-being, provide the moral foundation for requests for voluntary euthanasia.

Each consideration is necessary for moral justification of the practice, but taken in isolation neither suffices see, e. The technological interventions of modern medicine have had the effect of stretching out the time it takes for many people to die. Sometimes the added life this brings is an occasion for rejoicing; sometimes it drags out the period of significant physical and intellectual decline that a person undergoes with the result that life becomes no longer worth living.

If they are right, that simply points up the importance of individuals being able to decide autonomously for themselves whether their own lives retain sufficient quality and dignity to make life worth living. Others maintain that individuals can be in error about whether their lives continue to be worth living cf.

The conditions outlined above in Section 2 are intended by those who propose them to serve, among other purposes, to safeguard against such error. But it is worth adding that in the event that a person who considers that she satisfies those conditions is judged by her medical attendants to be in error about whether it would be worth her continuing to live, the likely outcome is that those attendants will refuse to provide medical assistance with dying.

Evidence that will be mentioned below shows that this happens frequently in jurisdictions in which medically assisted dying has been legalized. Unless a patient is able to be transferred to the care of other medical professionals who accept her assessment, she will have to rely on her own resources e.

Even so, other things being equal, as long as a critically ill person is competent, her own judgement of whether continued life is a benefit to her ought to carry the greatest weight in any end-of-life decision making regardless of whether she is in a severely compromised and debilitated state.

It might be thought that in such an eventuality different moral concerns will be introduced from those that arise in connection with competent refusals. After all, while competent patients are entitled to refuse any form of medical treatment, they are not entitled to insist on the administration of forms of medical treatment that have no prospect of conferring a medical benefit or are not being provided for reasons to do with scarcity of medical resources or affordability.

While each of these points is sound, it remains the case that medical personnel have a duty to relieve suffering when that is within their capacity.

Accordingly, doctors who regard medical assistance with dying as an element of appropriate medical care will consider it morally permissible to agree to a request for assistance with dying by a competent dying patient who wishes to avoid unnecessary suffering.

The reason for claiming only that this is morally permissible rather than morally obligatory will be explained in a subsequent paragraph. The justification for this rule is hard to find - many people think it's just an obvious truth philosophers call such truths self-evident. You find variations of this idea in many faiths; for example "do unto others as you would have them do unto you".

A rule is universalisable if it can consistently be willed as a law that everyone ought to obey. The only rules which are morally good are those which can be universalised. The person in favour of euthanasia argues that giving everybody the right to have a good death through euthanasia is acceptable as a universal principle, and that euthanasia is therefore morally acceptable.

If a person wants to be allowed to commit euthanasia, it would clearly be inconsistent for them to say that they didn't think it should be allowed for other people. But the principle of universalisability doesn't actually provide any positive justification for anything - genuine moral rules must be universalisable, but universalisability is not enough to say that a rule is a satisfactory moral rule.

Universalisability is therefore only a necessary condition, not a sufficient condition for a rule to be a morally good rule. So, other than showing that one pre-condition is met, universalisibility doesn't advance the case for euthanasia at all. Every case is different in some respect, so anyone who is inclined to argue about it can argue about whether the particular differences are sufficent to make this case an exception to the rule.

Oddly enough, the law of universalisability allows for there to be exceptions - as long as the exceptions are themselves universalisable. So you could have a universal rule allowing voluntary euthanasia and universalise an exception for people who were less than 18 years old. But it is one that is used a lot in discussion, and particularly in politics or round the table in the pub or the canteen.

People say things like "we can't control drugs so we'd better legalise them", or "if we don't make abortion legal so that people can have it done in hospital, people will die from backstreet abortions". What lies behind it is Utilitarianism : the belief that moral rules should be designed to produce the greatest happiness of the greatest number of people. If you accept this as the basis for your ethical code and it's the basis of many people's ethics , then the arguments above are perfectly sensible.

If you don't accept this principle, but believe that certain things are wrong regardless of what effect they have on total human happiness, then you will probably regard this argument as cynical and wrong.

From a utilitarian viewpoint, justifying euthanasia is a question of showing that allowing people to have a good death, at a time of their own choosing, will make them happier than the pain from their illness, the loss of dignity and the distress of anticipating a slow, painful death. Someone who wants euthanasia will have already made this comparison for themselves. But utilitarianism deals with the total human happiness, not just that of the patient, so that even euthanasia opponents who agree with utilitarianism in principle can claim that the negative effects on those around the patient - family, friends and medical staff - would outweigh the benefit to the patient.

It is hard to measure happiness objectively, but one way to test this argument would be to speak to the families and carers of people who had committed assisted suicide. Opponents can also argue that the net effect on the whole of society will be a decrease in happiness.

The only way to approach this would be to look at countries where euthanasia is legal. However, as no two countries are alike, it seems impossible to extricate the happiness or unhappiness resulting from legal assisted suicide, from any happiness or unhappiness from other sources. Even if you agree with the utilitarian argument, you then have to deal with the arguments that suggest that euthanasia can't be properly regulated.

If we put aside the idea that death is always a bad thing, we are able to consider whether death may actually sometimes be a good thing. This makes it much easier to consider the issue of euthanasia from the viewpoint of someone who wants euthanasia. The first two reasons form key points in the arguments against euthanasia , but only if you accept that they are true. The last two reasons why death is a bad thing are not absolute; if a person wants to die, then neither of those reasons can be used to say that they would be wrong to undergo euthanasia.

People are usually eager to avoid death because they value being alive, because they have many things they wish to do, and experiences they wish to have. Obviously, this is not the case with a patient who wishes to die - and proper regulation will weed out people who do not really want to die , but are asking for other reasons.

It thus follows that there can be such a thing as a life not worth living--one can judge that bodily life itself is useless or burdensome, and when it is, the person, i. Today a key in fighting euthanasia and assisted suicide is better care for the sick and dying. The dignity of the sick cannot be erased by illness and suffering. Such procedures are not private decisions; they affect the whole society.