From the likes of ancient Greek philosophers (Socrates, Seneca, Aristotle among others) to the legal precedents of modern day society, the practice of euthanasia has been the subject of debate among medical, legal and philosophical circles for more than three millennia. Despite astounding advancements in palliative medicine and end-of-life care, humanity continues to grapple with the ethics behind euthanasia, specifically whether patients may opt for or be granted the right to end their lives.
When we consider euthanasia today, more often than not it is seen as a sort of “mercy killing”, ending someone’s life, usually with their request, in order to prevent them from experiencing further suffering. Of course, with most things nowadays, voluntary euthanasia and physician-assisted suicide (PAS) is a widely contested topic, with many people fervently advocating for or denying the acceptance of such a cold method of ending one’s life. Most commonly, voluntary euthanasia ends with PAS, the pulling of the plug, for lack of a better term, being left up to a physician who has received explicit confirmation from a patient who is aware of what they are consenting to.
In terms of consent, a somewhat sketchy part of euthanasia involves the three key guidelines to be met for it to be considered informed consent, that is, the acceptance and acknowledgement of euthanasia when the patient is still able to make a voluntary choice, understands the choice they are making (with proper information being given) and still has the capacity to make medical decisions, often sealed with the signing of a proper legislative document. If these conditions are not met, even if one “consents” to euthanasia, it remains illegal in the eyes of the law. Why may this be a problem? In many cases where the ending of one’s life (legally) is taken into account as a choice, the person in question is often suffering from some sort of terminal illness, whether that be physical like the various types of cancers, or mental like dementia. As a disease progresses, most patients would thus begin to lose various cognitive abilities, especially so when their illness wreaks havoc on the nervous system, or even the brain, removing their ability to make decisions with clarity. Or, in the case of sudden instances that lead to grievous injury, the patient might immediately end up in a comatose state, and thus would not be able to even consider making the decision in the first place. Here lies a point of contention: when someone is physically or mentally incapable of deciding on euthanasia (under medical guidelines), what should be done?
More often than not, assuming the patient had not explicitly made a decision when they were still capable of it, the onus falls onto two groups of people – those in charge of their medical care, and their family members. This has sometimes led to conflict. In the worst case, the legal wrangling involved slowly winds its way through the byzantine court system, prolonging the agony for the patient’s family. For instance, the family may choose to keep the patient under assisted living (such as through the usage of ventilators) until their untimely demise. Doctors may, depending on their own personal stances on euthanasia, advocate for or against such a decision, putting pressure and influencing the final outcome. We must also consider scenarios in which the patient is not suffering from a terminal illness, but is unlikely to regain consciousness, such as in the case of comas and more specifically, irreversible brain damage. On the other hand, cases in which families do not agree with life-prolonging measures may also see opposition from the medical fraternity. This is especially so when the judiciary steps in - Karen Ann Quinlan’s case saw the hospital officials refusing her parents’ request for her ventilator to be removed. This eventually culminated in the landmark New Jersey Supreme Court case In re Quinlan, in which the court ruled that the rights of the parents (to make a private decision regarding their daughter) in this case superseded that of New Jersey’s homicide statutes. Another example is the US Supreme Court (1990, 497 U.S. 261)’s ruling that found that the “right to die” was not a right guaranteed by the US Constitution. In other words, US states are typically not permitted to intervene to grant families’ request to terminate life support. Today, the Five Wishes advance healthcare directive has offered reassurances to millions of Americans, sparing them from the emotional anguish that Cruzan and Quinlan’s families went through.
Five Wishes healthcare directive. Image Credit: North Fork Women for Women Fund, Inc.
There is a vast selection of factors to consider, each case bringing a new host of issues to the table, with the personal biases of family members and even the medical professionals involved tainting the lenses which the decision making process is viewed with. Take for instance the dubious morality of Canada, which legalized euthanasia in 2016 (or Medical Aid in Dying, as it was dubbed) when certain conditions were met. The following years saw widening of the MAID legislation to include those who were ill but not dying. Then those with mental illnesses. Even now, there are debates over allowing teenagers to ask for euthanasia. While countries which have outlawed this (most of the world, really) continue to contest the ethics behind this practice, Canada’s legalization of euthanasia has seen critics condemning what they perceive as a slippery slope towards a future where one can choose to die simply because they wish to. Opponents have painted the Canadian law as a twisted solution to a social net in a prolonged state of disrepair, where participants in the assisted death programme have previously fallen through the cracks. Devoid of societal support, isolated and often penniless, they eventually choose the ultimate solution. In addition, the lack of consensus on what constitutes reasonable community support services that may be extended to applicants of MAID as an alternative means that this is in fact a real possibility. Under immense pressure, the Canadian government has announced a 1 year moratorium (further extended till March 2024) on the inclusion of mental illness as an eligible condition for MAID to allow for more consultation and clarity among stakeholders.
Even among supporters of Canada's MAID legislation, many remain cautious of its implications on society. Image Credit: Cardus
Putting the concerning case of voluntary euthanasia aside, we must also address scenarios where euthanasia is performed on people who cannot provide informed consent (as mentioned above), more specifically because they do not wish to die or were not asked for their consent beforehand. While the term “involuntary euthanasia” sounds callous and highly offensive, cases are not exactly uncommon, even today. For example, patients may be coerced or forced to die because their care is expensive, burdensome or even fruitless. The divide between doctors and family comes into play pretty often when considering this. In 2017, a doctor in the Netherlands forcibly euthanised an elderly woman who suffered from dementia. While the victim had expressed a willingness to seek euthanasia (legal in the Netherlands), she had stated that the decision would be made only when “the time was right”. Despite this, the doctor’s verdict was that she was in “intolerable suffering”, eventually drugging the woman’s coffee with a sleeping aid and asking her family to restrain her when she woke up during the injection, screaming that she did not want to die. Horrifying, yes, but according to the Regional Review Committee, the doctor was “acting in good faith” and did not break any of the country’s euthanasia laws.
If one removes all personal feelings from the table, cases like the one above make sense from a purely logical standpoint. After all, why would we continue putting people through pain that they do not need to suffer? The morality of such a viewpoint, on the other hand, is dubious, if not completely immoral, and its continued circulation might lead to disastrous results. How many times have people committed terrible deeds in the name of what they thought was good? Professor Yusuke Narita from Yale University has suggested that elderly Japanese residents commit mass seppuku, a form of ritual suicide in order to resolve the ageing population crisis in 2021. While drawing backlash, he has resolutely stuck to his point (while acknowledging his words were harsh). More worryingly, he has amassed a wide following on social media of like-minded individuals who would euthanise the old, disabled and mentally ill because of their perceived burden on the country. As our biases bleed into society, we must tread carefully to prevent such radical thoughts from slowly morphing into mainstream consciousness.
Image Credit: Iona Institute
All things considered, the ethics of euthanasia clearly still divide opinion. While some say that it is the correct and ethical thing to do, especially when cases like Quinlan’s come to mind, while some also posit that a life is a life, and what gives us the right to decide on behalf of another person whether or not their life should come to an end. Both sides of the coin have valid and important arguments, making government stances on this a particularly thorny issue. Regardless, the issue of euthanasia, however touchy and sensitive, is a conversation that must take place in order to clear the air surrounding the legalities and moralities of euthanasia, giving people clear viewpoints and stands for them to make a decision.
References
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