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Active vs Passive Euthanasia, why is there still a debate?
Romantic Undead
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Registered User regular
Hey all,
I was having a conversation with friends regarding the ongoing controversy regarding Euthanasia, mainly the recent religious cases where certain people denied themselves treatment, prefering to allow themselves to die to accepting blood transfusions. This lead to further discussion as to the responsibilities of doctors vis-a-vis terminally ill patients.
It is my current understanding that in North America, it is illegal for doctors to actively offer euthanasia as an option to terminally ill patients. However, patients can sign a "do not recussitate" order and/or ask for treatment to be terminated, effectively letting whatever is afflicting them "take its course".
According to James Rachels, this is far more reprehensible than simply ending someone's suffering, and I tend to agree.
Why is it, in this day and age, that we still balk at the notion of ending someone's life early in the name of easing pain and suffering? Is it a vestige of puritanism that simply won't go away, or are there legitamate moral implications that I'm ignoring here? There are other parts of the First World (like Germany) where active euthanasia (i.e. doctors offering euthanasia to conscious and consenting patients) is practiced, why does North America continue to resist?
Allowing Active Euthanasia would reduce suffering and reduce the cost of keeping a dying person on life support for unnecessary amounts of time, what are the downsides?
I was having a conversation with friends regarding the ongoing controversy regarding Euthanasia, mainly the recent religious cases where certain people denied themselves treatment, prefering to allow themselves to die to accepting blood transfusions. This lead to further discussion as to the responsibilities of doctors vis-a-vis terminally ill patients.
It is my current understanding that in North America, it is illegal for doctors to actively offer euthanasia as an option to terminally ill patients. However, patients can sign a "do not recussitate" order and/or ask for treatment to be terminated, effectively letting whatever is afflicting them "take its course".
According to James Rachels, this is far more reprehensible than simply ending someone's suffering, and I tend to agree.
Why is it, in this day and age, that we still balk at the notion of ending someone's life early in the name of easing pain and suffering? Is it a vestige of puritanism that simply won't go away, or are there legitamate moral implications that I'm ignoring here? There are other parts of the First World (like Germany) where active euthanasia (i.e. doctors offering euthanasia to conscious and consenting patients) is practiced, why does North America continue to resist?
Allowing Active Euthanasia would reduce suffering and reduce the cost of keeping a dying person on life support for unnecessary amounts of time, what are the downsides?
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So I understand why some people are against euthanasia, even though I myself am not.
the "no true scotch man" fallacy.
the "no true scotch man" fallacy.
Furthermore, I think it's important to discuss the distinction between which is more relatively "bad": The end result (Death) or the Suffering that the patient must endure until he gets to that same end result.
In other words: If, to consider ourselves moral beings, we desire to prevent suffering in others, would it not behoove us to end suffering when it is within our power to do so, when we know the end result would be the same?
Please bear in mind I know we already have a Morality thread so I don't want this to become a discussion about morality in general, I just wanted to make clear that my basic understanding of morality is based on that notion.
Oh, I agree with you, in general. But I don't think there's really a way to get into this in any detail without delving into the pros and cons of consequentialist ethics, which would basically degenerate this thread into a new morality thread.
I will point out that there are legitimate pragmatic concerns. One is that we need to distinguish patients who are truly psychologically ready to die from patients who are simply depressed and tired of fighting. Another is that we need to be wary of hospitals or insurance companies pressing for euthanasia due to cost savings or expediency. Neither of these are deal-breakers, in my mind, just issues to be aware of if we ever were to legitimize euthanasia.
the "no true scotch man" fallacy.
It's legal in Oregon, under some rather strict guidelines.
However, I will say that if we're looking at consequentialism as an answer here, how is it relevant? The end result is that the patient dies, as far as I understand consequentialism, this debate has little ethical problem, since the means of death wouldn't matter. On the other hand, if the desired end result is to end suffering, then Rachel's argument holds true, and active euthanasia would result in the preferable outcome from a consequentialist point of view, no?
On to the pragmatic concerns, absolutely. If there's any argument to be made about active euthanasia, it has to be the slippery slope that it might allow. The question I'm bringing up here is, is this really an issue, or a case of overblown hysterics? Would value for human life really plummet that low that insurance companies will consider mass euthanasia as a cure for its bottom line? I'm an optimist, so I like to think that no, but I'm sure there are some people here who will disagree with me on that point.
Edit: Oh, you mean making euthanasia illegal is reprehensible. Nevermind then.
Well, nobody's going to be sitting rubbing their hands going, "Muwahaha, how can we make old people kill themselves?" But systems - not individual people, but institutions made up of commitees of people - have a way of valuing the dollar more than human life. So if, for example, it became easier for a hospital to get reimbursed for euthanasia than for a triple bypass, then you have that situation without any one specific person making a bad ethical decision.
the "no true scotch man" fallacy.
Why kill a person that bleeds money?
Some would argue that insurance companies already kill people for their bottom line.
While I know it might seem cool to be cynical, I'm talking about everyday people here, not your evil HMOs and Insurance companies. Why are normal people against active euthanasia?
Maybe they're not, and there's an evil conspiracy to quash the pro euthanasia movement so that evil HMOs and Insurance can continue making money, is that it?
Some people believe that doctors' roles is to preserve life, not end it.
Some people are uncomfortable with the notion that life might not be worth living under some circumstances.
Some people believe that euthanasia will lead to a slippery slope, devaluing human life even further.
the "no true scotch man" fallacy.
And when preserving a life becomes no longer possible, they should have to deal with the suffering of slowly degenerating and dying?
Ok, where does this notion come from? Why do these people think this? Why is our society having a hard time coming to grips with its mortality when Euthanasia is acceptable elsewhere?
And is this true in countries where euthanasia is legal? Does this slippery slope have a correct precedent, or is this just hysterical supposition on someone's part?
Hell, you could even argue that valuing the dollar over human life in some instances might be the more moral choice, with the added condition that the dollar is going to be used in some manner to benefit or preserve the life of another who could more effectively use it.
This situation for example: You, a 50 year old man, can have a life-saving operation for, let's say, $10,000. In the room next to you, there's two 50 year old men who can have a life-saving operation for $5,000 each. Should money be a factor?
One of the most strange and perverse things about private medicine is that it assigns a dollar value to medical care, at the patient level. Patients, and for that matter, doctors ought not worry about the dollar figure of the operation. If there is to be any sort of judgement of utility, it should be triage, and the decision should be made only by the doctor.
If it isn't in a situation where such a judgement is needed, then the decision of care should ultimately reside with the patient. If they cannot decide for themselves, for whatever reason, the decision should rest with those who have been previously empowered by the patient or the state to make a decision on behalf of the patient.
While I generally agree with this, my arguments stem from the fact that currently, in North America, the State (with the apparent exception of Ohio), will decide that preserving a dying patient's life is preferable to active euthanasia (i.e. acting to end the patient's life), while passive euthanasia (letting a disease run its course, killing the patient) is acceptable.
Fiscally, it doesn't make sense to keep a terminally ill person alive at the cost of the State, and, I argue, that it doesn't make sense morally either, if the patient expresses the will to end his life. So the question is, why is Active Euthanasia illegal (for the most part) in North America, and what can be done to change public perception?
While I feel the slippery slope argument vis a vis the value of human life has some merit, I feel it is ultimately debunked by the fact that active euthanasia does exist in other parts of the first world (namely, Germany) and it doesn't seem to have had a negative impact on public perception of the value of human life over there. So the question is, what's blocking us here? What needs to be down to prove to society that there's nothing morally questionable about ending a terminally ill patient's life before the affliction that is causing them suffering and costing the state thousands takes its course?
Please read the essay I linked in the OP (it's not very long and in plain speak) and see what James Rachels has to say and let me know what you think.
Personally, I'm in favor of euthanasia. The arguments for it (such as in this incredibly unfortunate woman's case) are compelling. The two main tracts taken by opponents of it consist of the crazy (You can search freep for their deeply insightful comments on Ms. Sebire's case if you want to be outraged) and the other: doctors shouldn't be allowed to hurt people
I'll ignore the first tract, because really, religious fundies are stupid and their concerns should always be ignored whenever it concerns people other than themselves. As for the second, it's an interesting conundrum, but I feel the solution is to simply have decent oversight: Mandatory second opinion from a physician reviewing the case but not actively treating the patient to confirm it is a terminal/untreatable illness, and only have a doctor or nurse who is morally comfortable with euthanasia actually administer the fatal drugs (and there are plenty of medical professionals who are in favor of euthanasia).
I'm going to say vestiges of puritanism, even though there is no commandment that says "Thou shalt keep your elderly alive as long as possible, even if they are in world altering pain".
Whatever, its from the same "respect for human life" segment that brought us abortion clinic bombers and stem cell research crazies.
We really need a better way of treating people before they die. It's like those doctors that were accused of euthanizing patients when they couldn't reach help after Katrina. If they load them up with morphine, the patients are comfortable. And then they die. If they hadn't, the patients would have been in unbearable pain, and would have died. It was a lose-lose situation for the doctors.
I absolutely agree with this, but want to address the "doctors shouldn't hurt people" stigma.
Rachels' argument is that by letting someone die, as opposed to actively killing them, is equally objectionable since the end result is the same. In the case of teriminally ill patients, the latter is even MORE reprehensible, since allowing someone to suffer needlessly is more cruel than simply ending their lives. What is it about ending life that is so morally reprehensible that people should be expected to endure untold suffering for the sake of "ethics"? I challenge the notion that "killing people is bad, m'kay" in every circumstance. A doctor engaging in Active Consenting Euthanasia should be lauded not demonised.
Just to make my position clear: This is only for the case of terminally ill patients who are conscious and mentally fit enough to make this decision. Obviously things get a lot more complicated when dealing with terminal comatose patients and the mentally damaged, though I most certainly could bring up the case of Robert Latimer and his daughter
Why does the patient have to be terminal to be considered for euthanasia? There are situations where a person has an untreatable condition that, while not terminal, reduce quality of life to zero.
People hate comparing humans to animals, but I will do it anyway. If your dog has failing kidneys you bring him to the vet who will mercifully euthanize him, because why the fuck would you want your dog to die horribly?. But if your dog has hip dysplasia and is in constant suffering, but very much not terminal, you will still bring him to the vet, unless you are a fucker.
Why do we insist on treating our loved ones worse than we treat our animal friends due to pseudo-spiritual mystical bullshit?
For the record I'm not an atheist either, I believe that a certain amount of suffering must be endured out of respect for life. But once suffering is all there is, when it takes the place of that person having a life, ending it is the correct and moral response.
For the purposes of the argument, having the same result (death) is what gives credence to the whole argument that, if given a choice between death and death+suffering, the clear moral choice is just death.
If the patient is not terminal, then we REALLY embark on a slippery slope, and we would need to have a very strictly defined slide on how much pain is too much. I mean, are we going to start shooting people in the head when they break their leg like we do horses? What if it's gangrene? Diabetes?
If immediate death isn't part of the equation, it becomes far too difficult to draw a line in the sand without completely advocating state-sanctionned suicide for any little thing.
Did you read the article I linked to? Because that woman isn't terminally ill. She's in horrible pain, yes. She looks like a monster, yes. She is blind, 100% dependent on caretakers, and will never, ever, ever get better, only worse, yes.
But it's a slippery slope to dose the lady up with opiates and let her slip away peacefully like she's asking?
Germany and the Netherlands have euthanasia laws that cover non-terminal but OH-MY-GOD-JUST-FUCKING-LET-ME-DIE conditions, and yet they have not descended into the murderous eugenic nightmares that people are worrying about.
I wonder why that is.
It's much easier to not do anything because the patient told you to, then to do something that goes against our natural instincts. I'm assuming of course that most people don't really want to have to kill another person. I'm not saying I'm against euthanasia. Alzheimer's runs pretty strongly in my family, and there's no way I'd want to end up like that in the end.
I just don't know how a huge change in thinking will ever be brought about in this country without some major changes in the legal system.
Really? Though appeals can be expensive, I really don't think it matches the cost of imprisonment. Regular 'ol life imprisonment gets appealed plenty of times too. If there's anyting out that backs this statement up, I'll gladly read it, but I was always under the impression that cost was one of the reasons pro-capital punishment lobbyists bandied about for their cause, not against.
This, of course, is absolutely true, and definately a problem, but no, I think, an insurmountable one.
totally makes sense, however, some, myself included, believe that our "natural instincts" regarding survival of the terminally ill is kindof twisted in a way. Philosophers argue that our natural tendency to be "moral" is muddied by an irrational fear of death, as though nothing can be worse than. Maybe this is all tied into the stigma of death being so scary and unknown that ANY fate HAS to be better.
You're absolutely right. I think, however, that these changes need to happen.
1) Patients may feel a burden of choice. Terminally ill patients are a heavy burden on their family and the hospital. Even if they wish to keep living, they may feel the responsibility to end their life. By not offering the option, they dont have to worry about it.
2) After active euthanasia, the doctor has become a killer. Even if it was acceptable, the doctor has killed someone.
3) The legislation and implementation of active euthanasia would be a fucking nightmare, and will likely lead to state sanctioned suicide. How do we determine who merits active euthanasia? The envelope will continue to be pushed.
4) Suicidal people may not receive the help they need.
Euthanasia should not be confused with suicide. A doctor should be able to easily determine whether his patient is truly suffering to the point where quality of life is gone, and cannot ever return, or if his patient is merely depressed.
Additionally, a retarded 8 year old should be able to readily determine this distinction also.
Thats quite an oversimplification.
Yeah. The kid would have to be at least nine.
Your statement "Even if it was acceptable, the doctor has killed someone", I feel, is an oversimplification.
The act of killing, in and of itself, does not brand a person as evil, least of all in this circumstance. Furthermore, I argue that letting someone die when you could prolong their life otherwise is just as bad, if not worse, than ending their suffering. I believe there is such a thing as showing mercy by killing, and that's what we're talking about here.
Euthanasia is doctor-assisted suicide. There's a reason there's a doctor involved and not say, next of kin or even the patient themselves. A doctor is trained to assess when quality of life is completely unrecoverable. I think part of the problem with the slippery slope argument that allowing euthanasia would decrease the value of human life overall is that it fails to take into consideration that not every patient is qualified to receive euthanasia. A doctor (possibly along with another doctor, who can offer an unbiased second opinion) has the responsibility to figure out whether or not 1) all possibilities of treatment have been exhausted and 2) how much quality of life the patient can expect faced with their final days.
This is not a light matter by any means, but I do believe it is reasonably responsible to assert that some people simply have nothing to look forward to but suffering from a certain point on within the development of their condition.
Should the burden on a patient's family be considered? I say yes, though it most certainly is NOT a permissible criterion for allowing euthanasia on its own. That being said, if I knew I had nothing but pain to look forward to until I die, not to mention the drawn out mourning and financial burden my family would be faced with, why would it be considered wrong of me to wish to free myself and they of suffering? What is the ethical reasoning behind prolonging that state?
"Killing is wrong", I believe, is not an adequate argument in this case.
Then a doctor should be able to assess that and hold off on administrating euthanasia until the patient is of proper and sound mind.
because doctors are magic!
Sorry, but determining these things are extremely hard. There is no test that can determine someone's state of mind, how much pain they are in, or their motives. Without a clearly set out line, the envelope will be pushed.
With modern medecine, there is no reason for a dying person to be in pain. They may not be able to do much, but we can ensure that a patient has no pain (This is coming from a doctor who spoke to my class who specializes in these cases).
Yes, the burden on society and the system should be considered, but if active euthanasia is an option, the patient may feel a responsibility to end their life, which is unacceptable.
And what I meant about the doctor killing is that doctors may not feel up to performing active euthanasia. Ending human life is not that great of a job.
Actually, there are, MRI scans can detect the levels of activity in the brain and it's chemical make up, which is enough to determine whether or not a person is suffering from a chemical imbalance.
Obviously, facing death is depressing, but if there are no factors outside of the patient's control (i.e. chemical imbalances) then mere sadness is not reason enough to be ethically opposed to euthanasia. Of course I'm going to be sad I'm dying, I'd rather be healthy and have many more years to live, but reality is what it is and when faced with an impossible decision, I believe shortening suffering is the morally correct objective.
False, please read the case on Tracy Latimer. Her condition was such that anti-pain medication would interfere with her treatment, which meant she was in constant, agonizing pain. While in many cases, it's perfectly possible to keep a patient completely sedated and barely conscious until they die, if they truly didn't feel any pain, then why would they be asking to die? Once again, a doctor, maybe a psychologist, can assess what kind of value that person is getting out of life in their last days.
Why? What's the moral reasoning behind choosing death as being unacceptable?
Well obviously I would recommend that for a doctor to be qualified to administer euthanasia, he should be subjected to a psychiatric examination to ensure that he is fully capable and willing to do the job being asked of him. Perhaps extra certification would be in order there.
"And the choice we will have given the elderly, terminally ill, and the disabled by legalizing PAS will almost certainly impose a devastating burden upon them. By giving them the choice to die, we will have also unwittingly upon these vulnerable people the added burden of having to justify their own continued existence, if not to others, at least to themselves, and this at a time when they feel useless, discouraged and a burden to others"
-Paul Chamberlain: A Case Against Physician-Assisted Suicide
One thing that I feel is wrong about this quote is that it supposed doctors would come up to patients and say "hey, by the way, you can die anytime now".
I believe active euthanasia should be allowed, but should never, under ANY circumstance, be presented to a patient as an option.
Active Euthanasia, as it's name implies, means the patient is the one taking action, at every step. The patient must request to die of his own free will, without any prior suggestion taking place.
For a doctor to offer death as pain relief before the patient has brought it up is criminally unethical.
So, we should legalize PAS really quietly so the patients dont know its an option.