Kathleen M. Foley, author of Competent Care for the Dying Instead of Physician-Assisted Suicide,
believes doctors should develop treatments for the physical and psychological problems of dying patients
rather than helping them commit suicide. Available data suggests most physicians do not receive training
in the care of dying patients. Dying patients experience physical symptoms such as pain, psychological
problems such as anxiety and depression and existential distress (described as the experience of life without
meaning.)(1) many of the physical and psychological problems can be treated. Furthermore, legalization
of physician-assisted suicide may deter physicians from developing treatments that could enhance the dying
patient's quality of life.
Euthanasia by definition means "a gentle and easy death", "the good death of another" or "mercy
killing."(2) There are two types of euthanasia currently recognized, active and passive euthanasia. Active
euthanasia is the taking of one's own life, or being killed, for example, by lethal injection. Passive
euthanasia is taking one's life with the assistance of another or just being allowed to die. In passive
euthanasia we simply refrain from doing anything to keep the patient alive, for example, refusing to
perform surgery, administer medication, give heart massage or use a respirator and let the patient die from
whatever illness is already present. It is important to understand the difference, because many people
believe that active euthanasia is immoral and passive euthanasia is morally all right. They believe that we
should actually never kill patients, but sometimes it is all right to let them die.
The main issue then is it morally permissible to kill or let someone die who is going to die soon anyway,
at the person's own request, as an act of kindness?
Throughout history, many people have thought that the distinction between active and passive euthanasia
is morally important: and many of those who condemned active euthanasia raised no objection against
passive euthanasia. Even by people who believed killing to be wrong, allowing people to die by not
treating them was thought in some circumstances to be all right. Even before Christ, Socrates was quoted
as saying, " ...bodies which disease had penetrated through and through he would not have attempted to
cure...he did not want to lengthen out good-for-nothing lives."(3) In the centuries that followed, both the
Christians and the Jews viewed allowing to die in circumstances of hopeless suffering, morally permissible.
It was killing that they adamantly opposed.
The Pope, stating the position of the Catholic Church, said "it is acceptable to allow the patient who is
virtually already dead to pass away in peace."(4) In a statement published in 1982, the American Medical
Association echoes the feeling of the Catholic Church saying, " we remain firm on our stand against mercy
killing, but allowing patients to die (in some circumstances) is all right."(5) So it seems, there is
widespread agreement that passive euthanasia is morally all right (in at least some cases), but active
euthanasia is much more controversial.
In essence what we seek is whether euthanasia active or passive is moral, or whether it is immoral. To
discover the truth we must examine the arguments or reasons that are given for or against it. If the
arguments in favor of euthanasia are persuasive and the arguments against
it can be rejected, then it is morally acceptable. And likewise, if after careful analysis we find a strong
case against euthanasia, we would have to conclude it to be immoral. I think this is true not only of
euthanasia, but of any moral issue.
The single most powerful argument in support of euthanasia is the argument of mercy. The main idea of
this argument is simple. Terminal patients sometimes suffer pain far beyond our comprehension. This
suffering can be so terrible that we cringe at the descriptions of such agony. The argument for mercy says:
Euthanasia is justified because it puts an end to that. It is not important to give gory details of the suffering
of the terminally ill, but it is important to keep these visions vividly imprinted in our minds so we can
appreciate the full force of the argument for mercy. If a person prefers and even begs for death as the only
alternative to lingering on in this kind of torment, only to die anyway after a while, then surely it is not
immoral to help this person die sooner. As Stewart Alsop (a respected journalist) stated prior to his death
from a rare
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Related TopicsEuthanasiaMedical ethicsDeathSuicideDisability rightsVoluntary euthanasiaAssisted suicideLegality of euthanasiaEuthanasia in the United States
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Unformatted text preview: EUTHANASIA AND A MODEST PROPOSAL 25 2‘5 The Morality of Euthanasia James Rachels James Rachels (1941—2003) argues that active euthanasia is sometimes morally permissible. Active euthanasia occurs when someone (typically a medical professional) takes action to deliberately end a patient's life, at the patient's request, for the patient's own good. Rachels argues that considerations of mercy play a vital role in justifying active euthanasia in many cases. He first considers a utilitarian argument on behalf of active eutha— nasia, but finds problems with utilitarianism that are weighty enough to undermine this argument. However, Rachels believes that a different version can succeed. In this one, Rachels claims that any action that promotes the best interests of all concerned, and that violates no rights, is morally acceptable. Since, he claims, active euthanasia sometimes satisﬁes this description, it"is sometimes morally acceptable. The Morality ofEut/mnasia 267 the comprehension of those who have not actually experienced it. Their suffering can be so terrible that we do not like even to read about it or think about it; we recoil even from the descriptions of such agony. The argument from mercy says euthanasia is justiﬁed because it prdvides an end to that. The great Irish satirist Jonathan Swift took eight years to die, while, in the words of Joseph Fletcher, “His mind crumbled to pieces.” At times the pain in his blinded eyes was so intense he had to be restrained from tearing them out with his own hands. Knives and other potential instruments of suicide had to be kept from him. For the last three years of his life, he could do nothing but sit and drool: and when he ﬁnally died it was only after convulsions that lasted thirty—six hours. Swift died in 1745. Since then, doctors have learned how to eliminate much of the pain that accompanies terminal illness, but the victory has been far from complete. So, here is a more modern example. Stewart Alsop was a respected journalist who died in 1975 of a rare form of cancer. Before he died, he wrote movingly of his experiences as a terminal patient. Although he had not thought much about euthanasia before, he came to approve of it after rooming brieﬂy with someone he called Jack: The third night that I roomed with Jack in our tiny double room in the solid—tumor ward of the cancer clinic of the National Institutes of Health in Bethesda, Md., 3 terrible thought occurred to me. Jack had a melanoma in his belly, a malignant solid tumor that the doctors guessed was about the size ofa softball. The cancer had started a few months before with a small tumor in his left shoulder, and there had been several operations since. The doctors planned to remove the softball-sized tumor, but they knew lack would soon die. The cancer had metastasized—it had spread beyond control. Iack was good—looking, about 28, and brave. He was in constant pain, and his doctor had prescribed an intravenous shot of a synthetic he single most powerful argument in support of euthanasia is the argument from mercy. It is also an exceptionally simple argument, at least in its main idea, which makes one uncomplicated point. Terminally ill patients sometimes suffer pain so horrible that it is beyond From “Euthanasia,” in Tom Beauchamp. ed., Matters ofLife and Death, Second Edition (1986). pp. 49—52 (McGraweHill Publishers). 266 opiate—a pain—killer, or analgesic—every four hours. His wife spent many of the daylight hours with him, and she would sit or lie on his bed and pat him all over, as one pats a child, only more methodically, and this seemed to help control the pain. But at night, when his pretty wife had left (wives cannot stay overnight at the NIH clinic) and dark— ness fell, the pain would attack without pity. At the prescribed hour, a nurse would give Jack a shot of the syn- thetic analgesic, and this would control the pain for perhaps two hours 268 MORAL PROBLEMS or a bit more. Then he would begin to moan, or whimper, very low, as though he didn’t want to wake me. Then he would begin to howl, like a dog. When this happened, either he or I would ring for a nurse, and ask for a pain—killer. She would give him some codeine or the like by mouth, but it never did any real good—it affected him no more than half an aspirin might affect a man who had just broken his arm. Always the nurse would explain as encouragingly as she could that there was not long to go before the next intravenous shot—“Only about 50 minutes now.” And always poor Iack’s whimpers and howls would become more loud and frequent until at last the blessed relief came. The third night of this routine the terrible thought occurred to me. “If Iack were a dog,” I'thought, “what would be done with him?” The answer was obvious: the pound, and chloroform. No human being with a spark of pity could let a living thing suffer so, to no good end. The NIH clinic is, of course, one of the most modern and best- equipped hospitals we have. Jack’s suffering was not the result of poor treatment in some backward rural facility; it was the inevitable product of his disease, which medical science was powerless to prevent. I have quoted Alsop at length not for the sake of indulging in gory details but to give a clear idea of the kind of suffering we are talking about. We should not gloss over these facts with euphemistic language or squea— mishly avert our eyes from them. For only by keeping them ﬁrmly and vividly in mind can we appreciate the full force of the argument from mercy: If a person prefers—and even begs for—death as the only alterna— tive to lingering on in this kind oftorment, only to die anyway after a while, then surely it is not immoral to help this person die sooner. As Alsop put it, “No human being with a spark of pity could let a living thing suffer so, to no good end.” The Utilitarian Version of the Argument In connection with this argument, the utilitarians deserve special mention. They argued that actions and social policies should be judged right or wrong exclusively according to whether they cause happiness or misery; and they argued that when judged by this standard, euthanasia turns out to be morally acceptable. The utilitarian argument may be elaborated as follows: The Morality ofEut/ztmusin 269 (1) Any action or social policy is morally right if it serves to increase the amount of happiness in the world or to decrease the amount of misery. Conversely, an action or social policy is morally wrong if it serves to decrease happiness or to increase misery. (2) The policy of killing, at their own request, hopelessly ill patients who are suffering great pain would decrease the amount of misery in the world. (An example could be Alsop’s friend Jack.) (3) Therefore, such a policy would be morally right. The ﬁrst premise of this argument, (1), states the Principle ofUtility, which is the basic utilitarian assumption. Today most philosophers think that this principle is wrong, because they think that the promo— tion of happiness and the avoidance of misery are not the only morally important things. Happiness, they say, is only one among many values that should be promoted: freedom, justice, and a respect for people’s rights are also important. To take one example: people might be happier ifthere were no freedom of religion, for ifeveryone adhered to the same religious beliefs, there would be greater harmony among people. There would be no unhappiness caused within families by Jewish girls mar— rying Catholic boys, and so forth. Moreover, ifpeople were brainwashed well enough, no one would mind not having freedom of choice. Thus happiness would be increased. But, the argument continues, even if happiness could be increased this way, it would not be right to deny people freedom of religion, because people have a right to make their own choices. Therefore, the ﬁrst premise of the utilitarian argument is unacceptable. There is a related difficulty for utilitarianism, which connects more directly with the topic of euthanasia. Suppose a person is leading a miser- able life—full of more unhappiness than happiness—but does not want to die. This person thinks that a miserable life is better than none at all. Now I assume that we would all agree that the person should not be killed; that would be plain, unjustiﬁable murder. Yet it would decrease the amount of misery in the world if we killed this person—it would lead to an increase in the balance ofhappiness over unhappiness—and so it is hard to see how, on strictly utilitarian grounds, it could be wrong. Again, the Principle of Utility seems to be an inadequate guide for determining right and wrong. So we are on shaky ground if we rely on this version of the argument from mercy for a defense of euthanasia. 270 MORAL PROBLEMS Doing What Is in Everyone's Best Interests Although the foregoing utilitarian argument is faulty, it is nevertheless based on a sound idea. For even if the promotion of happiness and avoidance of misery are not the only morally important things, they are still very important. So, when an action or a social policy would decrease misery, that is a very strong reason in its favor. In the cases of voluntary euthanasia we are now considering, great suffering is eliminated, and since the patient requests it, there is no question ofviolating individual rights. That is why, regardless of the difﬁculties of the Principle of Utility, the utilitarian version of the argument still retains considerable force. I want now to present a somewhat different version of the argument from mercy, which is inspired by utilitarianism but which avoids the difﬁ— culties of the foregoing version by not making the Principle of Utility a premise of the argument. I believe that the following argument is sound and proves that active euthanasia can be justiﬁed: 1. If an action promotes the best interests of everyone concerned and violates no one’s rights, then that action is morally acceptable. 2. In at least some cases, active euthanasia promotes the best interests of everyone concerned and violates no one’s rights. 3. Therefore, in at least some cases, active euthanasia is morally acceptable. It would have been in everyone’s best interests if active euthanasia had been employed in the case of Stewart Alsop’s friend Jack. First, and most important, it would have been in Jack’s own interests, since it would have provided him with an easier, better death, without pain. (Who among us would choose Jack’s death, if we had a choice, rather than a quick painless death?) Second, it would have been in the best interests of Jack’s wife. Her misery, helplessly watching him suffer, must have been almost unbearable. Third, the hospital staff’s best interests would have been served, since if Jack’s dying had not been prolonged, they could have turned their atten— tion to other patients whom they could have helped. Fourth, other patients would have beneﬁted, since medical resources would no longer have been used in the sad, pointless maintenance of Jack’s physical existence. Finally, if lack himself requested to be killed, the act would not have violated his rights. Considering all this, how can active euthanasia in this case be The Morality ofEuthmmsia 271 wrong? How can it be wrong to do an action that is merciful, that beneﬁts everyone concerned, and that violates no one’s rights? James Rachels: The Morality of Euthanasia 1. Would someone in circumstances like Jack’s be better off dead? That is, would dying quickly and painlessly be in his best interest? 2. What are Rachels’s objections to the principle of utility? Do you ﬁnd them convincing? 3. How does Rachels’s second argument differ from the utilitarian argu— ment? Do you agree with Rachels that it is a stronger argument? 4. Rachels claims that euthanasia cannot be said to violate anyone’s rights, given that the patient requests it. Do you ﬁnd this claim plausible? Is it possible to do something that violates someone’s rights even if he or she consents to it? 5. Rachels claims that (in some cases) active euthanasia promotes the interests of everyone concerned. If our society were to allow active eu- thanasia, would this be harmful to anyone’s interests? Why or why not? ...
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