Can Euthanasia Be Ethical Euthanasia: the Debate - Essay Example

Running head: Can euthanasia be ethical Can euthanasia be ethical al Affiliation Life is valued but in certain conditions when it is extremely painful or intolerable, the word euthanasia that is merciful end of life comes to the minds of patients, their families, or medical authorities. The aim of this essay is to discuss euthanasia, definition, types, religious, cultural, and ethical debate, to reach a conclusion of how and when euthanasia can be ethical (if ever). Can euthanasia be ethical Introduction The word euthanasia has its roots in the Greek word eu Thanatos, which literally means well or good death. This Greek word connotes an individual ending the life of another, inspired by supporting the best interest of the individual who dies. In this quest the most gentle available means are used. In other words ending life without pain and in dignity while the dying person is calm, serene, and surrounded by family, friends or loved ones (Michalsen and Reinhart, 2008). In this context, the practice of euthanasia was common in ancient Greece and Rome, where many people especially the disabled preferred to end their lives peacefully. However, after Hippocrates many of his scholars refused this concept. With emergence of Christianity the Hippocratic standpoint against euthanasia strengthened (Gupta et al, 2006). In the 19th Century, Darwin's theory, the Origin of Species, on human evolution introduced the notion of accidental natural mechanisms for selection, which turned to be a man-decided process of selection (Michalsen and Reinhart, 2008). In 1870, Samuel Williams (Congregational reverend, and professor of mathematics and natural philosophy at Harvard University) first suggested the use of anesthetic drugs and morphine for to end a patient's life intentionally (Gupta et al, 2006). After World War I, Germany experienced a period of economic difficulties, social and political unrest, which drove scientists and philosophers to revive Alfred Ploetz concept of racial hygiene. They raised the question of should non Aryans survive and share the Aryan race the limited resources. This was an ideology grasped by the racist Nazi regime and lead to overestimation of health and hygienic needs of the Aryans on the expense of others. In a natural progression this lead to the ideology of mercy killing to other non Aryan races (Michalsen and Reinhart, 2008). This essay aims at presenting euthanasia in the lights of different cultures and summarize the current debate reaching an answer to the question when is euthanasia ethical (if ever) Types of euthanasia Euthanasia classification is based on two foundations; first the wish of the sufferer into voluntary and involuntary, second is according to the way of carrying it out into active and passive (Goel, 2008). Voluntary euthanasia is when the sufferer expresses the sincerest wish to die and consciously asks for help to carry out that wish. The decision of voluntary euthanasia relates to two brain functions that have to be intact; first is cognition that is the capability to know, understand, analyze and using interpretive strategies. Second is emotional background stability of the sufferer, which affects the individual's ability to assess properly the condition parameters and decision making (Rismanchi, 2008). Involuntary euthanasia is when there is neither consent nor wish of the sufferer to end life, either because the sufferer cannot express the wish to die (like severe dementia or inability to communicate). Alternatively, the sufferer may be able to express the wish to die but does not give consent or ask for assistance commonly in cases of deep unrecoverable coma (Goel, 2008). Based on the way euthanasia is carried out, it is further classified into passive and active euthanasia. Passive euthanasia is when terminally ill patients sign DNR (Do Not Resuscitate) consent and allowed to die peacefully. Recently, the European Association of Palliative Care has seriously challenged this concept based on four arguments; first is the contradiction in terms between passive and euthanasia (act of ending life). The second argument was the principles of ethical permission and rightness of action, third was this way is not in reality euthanasia, and finally the serious consequences on the medical profession allowing such a way (Garrad and Wilkinson, 2005). Euthanasia in different cultures Individual attitudes towards euthanasia are more complicated than just saying an opinion with or against. This complexity in orientation comes from the interaction of many factors like age, gender, and race, nature of disease or disability, socio-demographic factors, cultural and religious backgrounds. Of these factors, religious and cultural factors are important as they shape the patient-physician attitude; and therefore; significantly affect the communication stream in-between (Sprung et al, 2007). The following discussion will focus of the religious and cultural backgrounds on euthanasia. Euthanasia in major religions Research has displayed the religious beliefs of physicians, patients, and families have a global influence of end-of-life decision making (Bulow et al, 2008). The following discussion will come to the common basic backgrounds of the major world religions on euthanasia. In Conservative Judaism, euthanasia, if voluntary, is considered a suicide on the part of the sufferer, and a murder on the part of who carries it out. It is different from the martyr where ending life is not the goal in itself, but the martyr may die seeking to carry out a greater goal. Although the motive in euthanasia may be admirable; yet the means brings a planned deliberate evil. Some founded their objection on the Old Testament statement Thou shall not kill; however a violent killing for gain, vengeance, or whatever cause is different from merciful end-of-life in euthanasia. After all, it remains that God who brings life and who takes it; further, suffering is a part of the Divine plan and man has no right to interfere with (Rosner, 1991). In 2006, Soen and Kibbutzim examined changes of beliefs on euthanasia in a sample of 127 Israeli social science college students. They inferred that religious beliefs play a significant role in building attitudes against euthanasia, but they also observed a modest support to physician-assisted euthanasia, which although very reserved, yet, is rising above religiosity. In Christianity, the quest of eternal life through repentance has overshadowed how healthcare should use end-of-life methods. The Christian quest of sanctity through submission to God rules out bringing death about either actively or passively. At the same time, it proscribes using medicine to postpone death or even save lives whatever the cost is. However, Christianity accepts using analgesics and sedatives to fight suffering giving the sufferer the chance to repent. Thus, the long-established Christian belief does not focus on dying with dignity; rather focus on dying with repentance and giving the sufferer a chance to prepare to repent. Another Christian commitment is salvation, where healthcare should be used up to the limit where the pursuit of health and postponement of death is used up. In addition, there is a Christian commitment to avoid harm, and to use medicine for that purpose unless social, economic, psychological, or moral cost barriers prevent that. Unlikelihood to achieve cure or health is another barrier, and basically a Christian individual is encouraged to accept treatment as long as there is a hope to achieve health as long as the treatment does not cost undue spiritual burden. According to the Christian Medical and Dental Association, if treatment effect is to prolong pain and suffering even if it postpones death, it may be suitable for a patient who still holds mental capacities to take a treatment stop decision. The Roman Catholic doctrine clarified when an individual my engage in patient's premature death that is conditioned by no violation of moral obligations, no direct intention to induce death. Finally, the patient death should not be the objective in itself; rather the aim is pain or therapeutic burden relief. This is the position of Orthodox and most Roman Catholic Christians, for Protestants, there are disagreements about euthanasia mainly in accepting passive but refusing active types (Engelhardt and. Iltis, 2005). In Islamic philosophy and laws, there is no recognition of the individual's right to die voluntarily. In Islam all life is divine given by Allah to individuals as an obligation, trust and responsibility, thus cannot be humanly ended by an intervention whether active or passive. Perhaps the only exception is to switch off life support equipment from a brain dead patient for the purpose of using these equipments to save the life of another patient (Aramesh and Shadi, 2007). For many Asians, Buddhism is the religion that describes death and the afterlife, and Buddhist teaching focus on death being a fact and inevitable. This is the reason most Buddhists are accepting death with calmness and dignity. There are no terms having similar connotation to euthanasia in Buddhist teaching; however, there are conditions where the value of life is questioned mentioned in Monastic Rule called Vinaya. Although the main purpose of this book is to guide monks in their life, yet, it can guide others regarding what to do in such situation. There are nearly 60 cases mentioned in this book mostly evolve around avoiding intolerable terminal care and reducing the sufferings of the severely disabled. Later, the book prohibited the provocation of death after noticing that some monks convinced a patient that death is a better option. In summary, euthanasia decision in Buddhism depends on weighing the quality of expected life against death, but it is still evil and a difficult decision to take (Keown, 2005). In Hinduism, there is no institutional religious structure nor there is a demand to stick to specific disciplinary dogma, rather it is a collection of beliefs and practices. Hindu beliefs in death do not center on the end life as death is a transition to another life by incarnation, living with God in heaven, or absorbed in Brahman (a representation of the ultimate reality). Thus, it accepts the diversity of life traditions, and the practitioners are to set the tradition for each patient with solid universal rules. In Hinduism, bad death is the unprepared for, the unexpected, and the violent death. The role of family is sacred to help the dying member before and after death. In summary, although suicide is prohibited, there are Hindu religious grounds for both voluntary and involuntary euthanasia (Firth, 2005). Cultural overlook on euthanasia In the context of euthanasia, culture plays the role of shaping how individuals recognize illness, suffering and dying. In societies with cultural diversity like USA, Australia, and Canada, cultural differences can be a barrier of communication between physicians and patients or their families. This creates a cross-cultural misinterpretation of euthanasia, and quality of care and life quality. Identifying that cultural differences create serious misunderstanding and different attitudes of truth telling, and decision making profiles about euthanasia, Singer and Blackhall (2001) conducted two case studies to point to how cross cultural communication can enhance both the process and outcome of patient care. They inferred although understanding the patient's backgrounds does not prevent disagreement on values, beliefs or practices; yet, it helps to recognize areas of negotiation on disagreements if they occur. The WHO Regional Office for Europe (2002) stated there is agreement as regards the patient's right of autonomy and non interference and considered this principle not controversial. About the right to ask for medical help for euthanasia, the Council of Europe surveyed 44 member states and showed that less than 10 states support the living will or advanced directive to end-of-life. Further, in countries where medical assistance to end a patient's life only two countries considered it non criminal in specific situations (Switzerland, and Estonia). In Belgium and Netherlands, the situation differs; this right is legalized and is looked upon as doing good and not killing. In UK, a parliamentary committee refused legalization of active end of life, because of the possibility that vulnerable individuals may not have adequate protection. The American perspective differs from the European viewpoint in that it is more individualistic concerned with micro-problems (those need immediate resolution) than moral problems. In other terms it is more focused on issues like the individual's rights than those like justice and social dimensions (Essex, 2000). Euthanasia: the debate The fundamental arguments about euthanasia are the freedom of an individual to end life which leads to another question, does a human owns its life or is just a gift from God, which an individual has to keep and maintain. In answering this question one should consider suicide which is condemned ethically, religiously, and in law. Second is the importance of life related only to its quality; however, this neglects others feeling like family and friends since a patient taking euthanasia decision does not consider the impact on his loving ones. Supposedly, in the same way an individual owns the right to end life, and then he or she must consider tolerating his pains because of others concerns and emotions. Third, since there are many factors influence the process of decision making, how can one be sure that right decision was taken (Ashraf, 2008) Doyle (2006) recognized the complex nature of debate and summarized it in few points, first, what is in the best interest of a patient The diversity of clinical scenarios when one might ask this question are evident, for example can withdrawal of an ongoing life support medication or procedure like artificial ventilation be in the patient's best interest If so, why to make the patient endures the pains and hardships of a disease process till death, if the patient cannot take the decision, can the decision making process extend to the family The second point in Doyle's argument is there a moral difference between active and passive euthanasia Doyle inferred that laws and professional practice guidelines should change to clarify the process of euthanasia and make physicians' role without guilt (self or societal). Thirdly, Doyle asked if assisted death differs morally from natural death in cases where no treatment is available. Doyle (2006) argued that if it is acceptable to let a patient dies in peace because the unavailability of specific treatment, then a further step to end of life based on patient's consent to relieve pains and suffering would be appropriate. Can euthanasia be ethical Goel (2008) reviewed the euthanasia laws in the Netherlands, USA, UK, and India, the author also reviewed the ethical aspects of euthanasia and inferred euthanasia can be ethical in the following situations: 1- If there is a fair and definite machinery of a penal of the authority who judged that a particular patient cannot survive. 2- If the consent for euthanasia is taken from the patient (if the patient can) and a member of family in addition. 3- There should be a judicial committee or body on a local level (district or state) to whom a plea of euthanasia is presented for final approval. 4- In cases where patients are not able or not trusted to take euthanasia decision, the board or committee may contribute the decision based on request from closest family member and medical authority. 5- The cases considered as candidates for such a decision are irreversible and incurable conditions. Conclusion For a terminally ill patient the decision of merciful end-of-life is not an easy one, as such a patient must be busy thinking of afterlife, religious beliefs are expected to overshadow rational thinking. Cultural beliefs, age, and socioeconomic factors are also influential. The ethical debate is active, on the part of medical authorities, feeling of guilt and societal look cast their shadow on medical decisions. There is a need for legislators and medical ethics researcher to clarify the whole subject, put unambiguous guidelines that consider morality, religion, culture and above all patients' best interests in consideration. Until then, it seems that no single authority, whether the patient, doctors, or family can take a justifiable decision of euthanasia. References Aramesh, K., and Shadi, H. (2007). Euthanasia: An Islamic Ethical Perspective. Iranian Journal of Allergy, Asthma, and Immunology, 6(Suppl. 5), 35-38. Ashraf, D. (2008). Euthanasia: A Boon to Society. Retrieved 1/05/2009, from http://www.writing.ucsb.edu/faculty/dean/50/2008papers/ashraf.pdf Bulow, H., H., Sprung, C., L., Reinhart, K., Prayag, S., Du, B. et al (2008). The world's major religions' points of view on end-of-life decisions in the intensive care unit. Intensive Care Med, 34(3), 423-430. Doyle, L (2006). Dignity in dying should include the legalization of non-voluntary euthanasia. Clinical Ethics, 1, 65-67. Essex, K., H. (2000). Euthanasia. TMSJ, 11(2), 191-212. Garrad, E., and Wilkinson, S. (2005). Passive euthanasia. Journal of Medical Ethics, 31, 64-68. Goel, V. (2008). Euthanasia-A dignified end of life! International NGO Journal, 3(12), 224-231. Gupta, D., Bhatnagar, S., and Mishra, S. (2006). Euthanasia: Issues Implied Within. The Internet Journal of Pain, Symptom Control and Palliative Care, 4(2). Retrieved 30/04/2009, from http://www.ispub.com/journal/the_internet_journal_of_pain_symptom_control_and_palliative_care/volume_4_number_2_41/article/euthanasia_issues_implied_within.html Engelhardt, H., T, and Iltis, A., S. (2005). End-of-life: the traditional Christian view. Lancet, 366, 1045-1049. Firth, S. (2005). End-of-life: a Hindu view Lancet, 366, 682-686. Keown, D. (2005). End of life: the Buddhist view. Lancet, 366, 952-955. Michalsen, A., and Reinhart, K. (2006). "Euthanasia": A confusing term abused under the Nazi regime and misused in present end-of-life debate. Intensive Care Med, 32(9), 1304-1310. Regional Office for Europe . (2002). Ethics of the Health System. Stockholm: WHO. Rismanchi, M. (2008). Chronic pain and voluntary euthanasia. J Med Ethics Hist Med, 1, 2-4. Rosner, F. (1991). Jewich Perspetives on Death and Dying. Jewich Medical Ethics, 2(1), 38-45. Singer, M., K., and Blackhall, L. J. (2001). Negotiating Cross-Cultural Issues at the End of Life: "You Got to Go Where He Lives". JAMA, 286, 2993-3001. Soen, D., and Kibbutzim (2006). The Freedom to Die with Dignity - Religiosity and Attitudes towards Euthanasia among Israeli Social Sciences Students. European Journal of Social Studies, 3(2), 1-19. Sprung, C., L., Maia, P., Bulow, H., H., Ricou, B., Armaganidis, A., et al (2007). The importance of religious affiliation and culture on end-of-life decisions in European intensive care units. Intensive Care Med, 33, 1732-1739. Read More