moral issues of euthanasia essay

• - Google Chrome

Intended for healthcare professionals

• Access provided by Google Indexer
• My email alerts
• BMA member login
• Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

• Advanced search
• Search responses
• Search blogs
• News & Views
• Euthanasia and...

Euthanasia and assisted dying: the illusion of autonomy—an essay by Ole Hartling

Read our coverage of the assisted dying debate.

• Related content
• Peer review
• Ole Hartling , former chairman
• Danish Council of Ethics, Denmark
• hartling{at}dadlnet.dk

As a medical doctor I have, with some worry, followed the assisted dying debate that regularly hits headlines in many parts of the world. The main arguments for legalisation are respecting self-determination and alleviating suffering. Since those arguments appear self-evident, my book Euthanasia and the Ethics of a Doctor’s Decisions—An Argument Against Assisted Dying 1 aimed to contribute to the international debate on this matter.

I found it worthwhile to look into the arguments for legalisation more closely, with the hope of sowing a little doubt in the minds of those who exhibit absolute certainty in the matter. This essay focuses on one point: the concept of “autonomy.”

(While there are several definitions of voluntary, involuntary, and non-voluntary euthanasia as well as assisted dying, assisted suicide, and physician assisted suicide, for the purposes of brevity in this essay, I use “assisted dying” throughout.)

Currently, in richer countries, arguments for legalising assisted dying frequently refer to the right to self-determination—or autonomy and free will. Our ability to self-determine seems to be unlimited and our right to it inviolable. The public’s response to opinion poll questions on voluntary euthanasia show that people can scarcely imagine not being able to make up their own minds, nor can they imagine not having the choice. Moreover, a healthy person answering a poll may have difficulty imagining being in a predicament where they simply would not wish to be given the choice.

I question whether self-determination is genuinely possible when choosing your own death. In my book, I explain that the choice will always be made in the context of a non-autonomous assessment of your quality of life—that is, an assessment outside your control. 1

All essential decisions that we make are made in relation to other people. Our decisions are affected by other people, and they affect other people. Although healthy people find it difficult to imagine themselves in situations where they do not decide freely, it is also true that all of us are vulnerable and dependent on others.

Yet autonomy in relation to assisted dying is often viewed in the same way as our fundamental right to choose our own course in life. If we are able to control our lives, then surely we can also control our death. Autonomy with respect to your own death, however, is already halved: you can choose to die if you don’t want to live, but you cannot choose to live if you are about to die.

Decisions about your own death are not made in normal day-to-day contexts. The wish to die arises against a backdrop: of desperation, a feeling of hopelessness, possibly a feeling of being superfluous. Otherwise, the wish would not be there. Thus, it is under these circumstances that the right to self-determination is exercised and the decision is made. Such a situation is a fragile basis for autonomy and an even more fragile basis for decision making. The choice regarding your own death is therefore completely different from most other choices usually associated with the concept of autonomy.

Here are just some of the critical matters that would arise if assisted dying were legalised.

A duty to die

The possibility of choosing to die would inhabit everyone’s consciousness—the patient, the doctor, the relatives, and the care staff—even if not formulated as an out-and-out offer. But if a law on assisted dying gives the patient a right to die, that right may turn into a duty to die. How autonomously can the weakest people act when the world around them deems their ill, dependent, and pained quality of life as beyond recovery?

Patients can find themselves directly or indirectly under duress to choose that option if they consider themselves sufficiently pained and their quality of life sufficiently low. Patients must be at liberty to choose assisted dying freely, of course—that is how it is presented—but the point is that the patient cannot get out of having to choose. It has been called the “prison of freedom.”

Internalised external pressure

Pressure on the patient does not have to be direct or articulated. As pointed out by the US professor of biomedical ethics Daniel Sulmasy it may exist as an “internalised external pressure.” 2 Likewise, the French bioethicist Emmanuel Hirsch states that individual autonomy can be an illusion. The theologian Nigel Biggar quotes Hirsch saying that a patient “may truly want to die, but this desire is not the fruit of his freedom alone, it may be—and most often is—the translation of the attitude of those around him, if not of society as a whole which no longer believes in the value of his life and signals this to him in all sorts of ways. Here we have a supreme paradox: someone is cast out of the land of the living and then thinks that he, personally, wants to die.” 3

The end of autonomy

An inherent problem of autonomy in connection with assisted dying is that a person who uses his or her presumed right to self-determination to choose death definitively precludes himself or herself from deciding or choosing anything. Where death is concerned, your right to self- determination can be exerted only by disposing of it for good. By your autonomy, in other words, you opt to no longer have autonomy. And those around must respect the right to self-determination. The respect refers to a person who is respected, but this is precisely the person who disappears.

Danish philosopher Johannes Sløk, who supported legalisation, said, “The actual concept of death has no content, for death is the same as nothing, and one cannot choose between life and nothing. Rather, therefore, one must speak of opting out; one opts out of life, without thereby choosing anything else. Death is not ‘something other’ than life; it is the cessation or annihilation of life.”

Autonomy is a consistent principle running through the care and management of patients and is enshrined in law. However, a patient’s autonomy means that he or she has the right to decline any treatment. It does not entail a right to have any treatment the patient might wish for. Patients do not have the right to demand treatment that signifies another’s duty to fulfil that right. If that were so, autonomy would be the same as “autocracy”—rule of the self over others. Even though patients have the right to reject any intervention, they do not have the right to demand any intervention. Rejecting any claim that the person might make is not a violation of a patient’s self- determination—for example, there may be sound medical reasons for not complying with a demand. The doctor also has autonomy, allowing him or her to say no. Refusing to kill a person or assist in killing cannot be a violation of that person’s autonomy.

The killing ban

Assisted dying requires the doctor’s moral and physical help. It is a binding agreement between two people: the one who is to be killed and the one who is to kill or assist in killing. But our society does not condone killing as a relationship between two legally competent, consenting people. Exemptions from the killing ban involve war or self-defence and are not justified on the grounds that the killing is done for the “benefit” of someone else.

Valuation of a life

If the action is to be decriminalised, as some people wish, it means the doctor will have to enter into deliberations and arguments for and against a request for assisted dying each time. That is, whether he or she is willing to grant it. The alternative would be to refer the patient to another doctor who might be willing to help—that doctor would still have to assess whether the patient’s life was worth preserving.

Thus, autonomy is not the only factor or even always the key factor when deciding whether assisted dying can be granted. It is not only the patient’s own evaluation that is crucial. The value of the patient’s life must also be assessed as sufficiently low. This demonstrates the limitation of the patient’s self-determination.

Relieving suffering

If a competent and legally capable person must have the option of voluntarily choosing assisted dying in the event of unbearable suffering, why does suffering have to be a requirement? The answer is straightforward: our concepts of assisted dying imply that compassion must form a crucial aspect of the decision—mercy killing and compassionate killing are synonyms. But this leads instantly to the question of why we should not also perform assisted dying on people who are not in a position to ask for it themselves but are also suffering.

Some people find the reasoning unproblematic. It stands to reason that relieving suffering is a duty after all. But in this context it is not unproblematic, because it effectively shifts the focus from the autonomy claimed. According to prevailing ideas about autonomy, patients initially evaluate their quality of life themselves, but ultimately it is those around them who end up gauging that quality and the value of their life. That is to say, the justification for assisted dying is borne on the premise that certain lives are not worth living rather than the presence of a request. The whole point is that in the process, respect for the right to self-determination becomes relative.

Autonomy is largely an illusion in the case of assisted dying. 1 A patient overwhelmed by suffering may be more in need of compassion, care, and love than of a kind offer to help end his or her life. It is not a question of whether people have a right to say that they are unworthy. It is a question of whether they have a right to be believed when saying it.

Ole Hartling is a physician of over 30 years standing, doctor of medical sciences at the University of Copenhagen, professor of health promotion at the University of Roskilde, and an author and co-author of several books and scientific articles published mainly in Scandinavia. Between 2000 and 2007 he was a member of the Danish Council of Ethics and its chair for five years. During this time, the council extensively debated the ethics of euthanasia and assisted dying.

Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

• Gastmans C ,
• MacKellar C

Today’s Moral Issues: Euthanasia Essay

Explain two arguments made by the court concerning assisted suicide in the glucksberg case. are you convinced.

The court clearly stated that it is a criminal offense to attempt or commit suicide. This law was formulated to protect and preserve human life (Bosselman 113). To ensure that the right to life is respect, the law was amended to include assisted or aided suicide as a criminal offense. Thus is an individual knowingly administered drugs or supplied weapons that will be used for murder, and then he is equally guilty. Further amendments were made to protect the dignity and independence of professionals. The amendments stated that withdrawal or withholding treatment that sustains the life of an individual by his/her request does not amount to assisted suicide. This law however ruled out physician-assisted suicide. The arguments are convincing enough since they aim at protecting and preserving the life of individuals.

What are Rachel’s criteria for allowable euthanasia; do you agree?

According to Rachel, euthanasia is only allowed if and only if the victim is suffering from unbearable pain. This exception should be administered to patients who are suffering from terminal illnesses, their chances of survival are slim and they are undergoing a lot of pain. He thus stated that euthanasia should be administered if the morals behind the action were justifiable and would result in happiness and killing a patient who is suffering from a terminal illness and undergoing a lot of pain by his/her request. Personally, I think that these criteria are justifiable as they will lead to more good than bad.

Explain William’s nature-based argument concerning euthanasia. What might be an objection?

The article that was presented by William clearly states that our bodies have a natural instinct of continuing to live. That is why in our everyday life we take many precautions to ensure that we are free from danger so that we can continue living. In our everyday lives, we take a lot of care to minimize the chances of us falling into danger or compromising situations that might compromise our health. That is why we dodge trucks, take medicine, eat, drink, work out, and ensure that we live healthy lives.

Our internal body organs also work hard to ensure our well being. When we bleed, the capillaries automatically close up and fibrinogen is released to speed up the blood clotting process to prevent further bleeding. Our cells also have antibodies that kill any foreign material which may have caused harm to our body. Therefore, it is a natural instinct that we are alive and struggles by all means to survive

Euthanasia on the other hand denies us this chance by intentionally taking away our life. This can only be objected to when an individual is suffering and the chances of recovery are low. It makes all the work which our bodies have worked hard to ensure that we continue to live. As a result, euthanasia goes against the laws of nature which ensure our continued living on earth.

How does the argument concerning utility apply to the case of “Jack”? Do you think that Jack would agree?

Jack was a patient who was suffering from cancer. His infections begun from his stomach but with time it had spread to several parts of his body, including his stomach. Although he used to receive comfort from his wife, he used to undergo a lot of pain at night when his wife was no longer there to comfort him. This is because it was against the policy of the hospital to have a family of friends over at night. During this time, Jack would suffer from severe pain which caused him a lot of discomforts. The doctor could administer painkillers to him to reduce the pain but this only worked for a few hours and most of the time, he had to rely on the painkillers which he was given by the nurses to relieve his pain.

As such, Jack would have benefited from the concept of utility. The pain and suffering which he and his family were undergoing could have been solved by euthanasia. Through euthanasia, all the pain and suffering which Jack was undergoing could have been solved. Furthermore, he was the right candidate for such treatment since he was suffering from and the chances of his recovery were slim. I personally believe that if Jack was offered the option to end his life, he would have chosen it.

What is Rachel’s’ critique of the “unexpected cures” argument? Is he right?

The argument raised by Rachel about unexpected cures is something which many people hope for when they are sick or have a loved one who is terminally ill. According to this argument, it is difficult to determine when the right time to administer euthanasia is. This is because there are chances that a patient can recover from conditions which were thought to lead to his/her death. In such instances therefore it will be morally wrong to administer euthanasia as it would deny the patient more time on earth which he or she deserves. Such instances occur when a wrong diagnosis were made by a doctor or there was a mistake in the interpretation of the patient`s condition by a doctor or a cure of the condition is found through research.

However, looking at this point critically, the probability that such recoveries can occur is very low. Thus, making decisions bases on such beliefs will only result to more harm than good. Many patients have suffered while they believed that they might get better or a cure for their condition will be found. It is therefore wise to make decisions based on facts. That is why euthanasia should be used to control such pains and sufferings.

How does the story of the petrol driver illustrate the golden rule notion as applied to euthanasia according to Rachel’s?

The story of the petro driver states clearly shows the golden rule in practice. It was about a driver who was trapped inside a petrol truck that had just rolled over as a result of an accident. In the process of trying to escape, the driver noticed that he was trapped and could not get out in time. He also understood that there was little which the people who stood close by could do. He thus requested them to hit him on his head so that he can die quickly and avoid the agony of roasting to death.

If the same driver had a chance to do the same thing on another person under similar circumstances, he would have done it. This is how the golden rule applies under euthanasia. It aims at the pain of death which an individual may suffer from by making his/her death to be quick and brief.

Will voluntary euthanasia be legal in the U.S. in, say, ten years?

Voluntary euthanasia will not be legal in the U.S for a very long time. This is because it goes against all morals of life. The state has an obligation to protect and preserve the life its citizens. That is why it has formulated many rules, laws and procedures which ensure that the right to life is respected and adhered to by everyone including the individual who wants to committee suicide. Therefore, the state will be going against its ethics by legalizing voluntary euthanasia. At the same time, if euthanasia is legalized, people will not have the respect to life.

Bosselman, Klaus. The principle of sustainability: transforming law and governance. New York: Ashgate Publishing, 2008.

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2024, March 16). Today's Moral Issues: Euthanasia. https://ivypanda.com/essays/todays-moral-issues-euthanasia/

"Today's Moral Issues: Euthanasia." IvyPanda , 16 Mar. 2024, ivypanda.com/essays/todays-moral-issues-euthanasia/.

IvyPanda . (2024) 'Today's Moral Issues: Euthanasia'. 16 March.

IvyPanda . 2024. "Today's Moral Issues: Euthanasia." March 16, 2024. https://ivypanda.com/essays/todays-moral-issues-euthanasia/.

1. IvyPanda . "Today's Moral Issues: Euthanasia." March 16, 2024. https://ivypanda.com/essays/todays-moral-issues-euthanasia/.

Bibliography

IvyPanda . "Today's Moral Issues: Euthanasia." March 16, 2024. https://ivypanda.com/essays/todays-moral-issues-euthanasia/.

• Euthanasia: Every For and Against
• Singer’s Views on Voluntary Euthanasia, Non-voluntary Euthanasia, and Involuntary Euthanasia
• Euthanasia: Is It the Best Solution?
• Rachel’s Stance on Euthanasia: Passive and Active Killing
• Euthanasia: Is It Worth the Fuss?
• Why Active Euthanasia is Morally Wrong
• Euthanasia Moral Permissibility
• Euthanasia and Assisted Suicide
• Euthanasia and Modern Society
• Active Euthanasia: Ethical Dilema
• Research Ethics: Tri-Council Policy Statement
• Controversial Issues of Euthanasia Decision
• Health Fraud: HIV/AIDS and Sexual Enhancement Scams
• Confronting Physician-Assisted Suicide and Euthanasia
• "The Triumph of Autonomy in American Bioethics" by Wolpe

The Moral Issues of Euthanasia

Medical treatment, as we all know, can help save lives. But Is there a medical treatment that will help people die? Although there is a lot of debate about it, doctors still use the procedure to help in the death of a patient. Euthanasia is also known as mercy killing. It is the method of ending a life to free a person from an incurable illness or intolerable suffering.

What exactly is euthanasia?

Euthanasia, also known as “Mercy Killing” and “Physician-Assisted Suicide.” It is a term used in medical ethics to describe interfering with a natural process to death. In other words, it accelerates the natural course of death in terminally ill patients when all treatments fail or become much too difficult for the patient to bear. In short, euthanasia is the intentional termination of human life to relieve unbearable pain. 

Moral Issues of Euthanasia

The following are the moral issues of physician-assisted suicide:

1. Autonomy about the timing and manner of one’s death 

It affects the impact of Assisted Suicide on those who participate in the suicide.

The main argument favoring euthanasia is that every responsible person should have decision-making power over him or herself.

Every person should be able to choose the time and manner of his or her death. A fundamental liberty interest should be: 

• Experiencing the quality of life
• Avoiding extreme pain and suffering
• Maintaining dignity
• Having a sense of power
• Having others remember us 

Proponents of assisted suicide argue that the right to autonomy, especially at the end of life, superior the claim that life must be preserved. Moreover, when a person’s condition is terminal, and death is imminent, the sacredness of life is greatly reduced.

It is nice for a person to be able to choose the time and manner of his or her death. But this decision must consider the effect it would have on others. Medical practitioners who assist with suicides will become immune to their natural prohibitions against ending another person’s life over time. This will undoubtedly impact how these physicians and others close to them view the importance of life preservation.

2. Death with Dignity

The second major argument favoring legalizing euthanasia is that people have the rights to die with dignity.

The last months of a person’s life should not be spent in severe physical pain, dependent on others for nutrition, hydration, and bodily hygiene, deteriorating physically and mentally , and experiencing a declining vision, hearing, and mobility. Family members, relatives, and friends do not have to witness a loved one’s decline and suffering. Our final thoughts about a loved one should be filled with joy and respect.

Clearly, the above point is valid and logical. The statement, though, has some serious shortcomings. First, the statement ignores the issues of human life sanctity and the many unintended effects of assisted suicide legalization. Second, the research and studies do not support the argument that people choose euthanasia because they are in extreme physical pain.

3. Utilitarian Reasoning

Another point advanced by proponents of assisted suicide is that the benefits outweigh the costs. Supporters contend that euthanasia helps terminally ill patients avoid needless suffering and pain in their final days. It allows a patient to have control over the timing and manner of death. And that it promotes death with dignity. At the end of life, an individual’s right to self-determination is honored. 

On the other hand, the costs are that certain people may feel pressured to end their lives based on a misunderstanding of their diagnosis, depression, concern for the burden they put on others, and the loss of assets. Likewise, selfish family members or caregivers can put pressure on some people to end their lives. Proponents of euthanasia argue that the benefits outweigh the costs and that detailed policy, education, and monitoring can help reduce many of the potential negative consequences.  

Moreover, supporters argue that the negative consequences are speculative, while the positive consequences are clear. Supporters argue that we do not punish deserving terminally ill patients just because we can imagine the worst-case situation. 

4. Sanctity of Human Life

The sanctity of human life is one of the key reasons against euthanasia. According to this argument, each person’s body is made in the image of God. It is God’s property, and no one has the authority to destroy God’s property. Because God created life, only God has the right to take it. Suicide is a betrayal of God’s sacred trust of life. It is a rejection of God’s supremacy. Life should not be terminated or shortened for the sake of a patient’s comfort. There is no more or less sacred human life than another. Individual autonomy takes a back seat to the sanctity of human life.

5. Diagnosis and Prognosis Mistakes 

Proponents of physician-assisted suicide contend that terminally ill patients who are competent and have fewer than six months to live should have the right to end their lives.

Also, assuming the legislation’s logic, advocates are assuming that physicians will be able to diagnose a patient’s condition and prognosis properly; determine if the patient is terminally ill; if the patient has less than six months to live; whether the patient is competent; whether the patient is acting under duress; and whether the patient’s pain and depression can be treated. 

Proponents of Euthanasia contend that it should be legalized. This is because there is no difference between withdrawing life-sustaining medical care and prescribing a pill. 

6. The end result is the same: a dignified and humane death

If this is a valid point, then it is equally valid to contend that there is no difference between giving someone a pill (physician-assisted suicide) and giving them an injection (Euthanasia). It is also logical that if we can prescribe medication or inject someone who has incurable pain who has a life expectancy of fewer than six months, we should be able to prescribe medication and inject someone who has incurable pain who would die within a year, five years, or ten years. 

The Bottom Line

Individuals must accept the moral prohibition against killing themselves or others for humanity to flourish as an interdependent community of dignity and equality. If this is a moral order truth, it will be shown by the fruits of human experience. In the long run, the axioms “Truth is Wonderful” and “Will Prevail” are right. In the short run, moral errors and mistaken moral values can cause societal suffering and misery.

Stay Up To Date With The Latest Health Trends!

Signup below you may opt out anytime..

John Astran

John is an avid writer. Traveling the world, focused on health and wealth related topics from conceptual ideas to Science.

Pros and Cons of Euthanasia: Learn Everything!

Should tv commercials for alcohol/fast-food be banned, you may also like, 25 unfortunate things that happen if you do..., 13 surprising health benefits of coffee, artificial intelligence and lung cancer: everything you should..., building meaningful relationships to support your mental health, what to do during this american heart health..., the truth behind using sleeping aids, 7 major differences between organic and non organic..., 5 top reasons for frequent heartburn that may..., valley fever: signs, symptoms, and management, 10 of the most sustainable foods in the....

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• J R Soc Med
• v.111(11); 2018 Nov

Euthanasia and assisted dying: what is the current position and what are the key arguments informing the debate?

Andreas fontalis.

1 St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK

Efthymia Prousali

2 Aristotle University of Thessaloniki, 54124 Thessaloniki Greece

Kunal Kulkarni

3 University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK

Assisted dying is a highly controversial moral issue incorporating both physician-assisted dying (PAD) and voluntary active euthanasia. End-of-life practices are debated in many countries, with assisted dying receiving different consideration across various jurisdictions. In this paper, we provide an analytic framework of the current position and the main arguments related to the rights and moral principles concerning assisted dying. Assisted dying proponents focus on the respect of autonomy, self-determination and forestalling suffering. On the other hand, concerns are raised regarding the interpretation of the constitutional right to life and balancing this with the premise of assisted dying, alongside the impacts of assisted dying on the doctor–patient relationship, which is fundamentally based on trust, mutual respect and the premise of ‘first do no harm’. Our review is underpinning the interpretation of constitutional rights and the Hippocratic Oath with the premise of assisted dying, alongside the impacts of assisted dying on the doctor–patient relationship. Most clinicians remain untrained in such decision making, with fears against crossing key ethical divides. Due to the increasing number of cases of assisted dying and lack of consensus, our review enables the integration of ethical and legal aspects and facilitates decision making.

Introduction

Assisted dying remains a highly controversial moral issue, with clinical, legal, political, religious and ethical considerations playing an important role. Lack of consensus and ongoing debate are features of modern life, while the law generally sustains a broader, pluralist outlook. Advances in both life-prolonging treatments and palliative care in recent years are inextricably intertwined with this complex topic, resulting in the continuing demand for amendments on current legislations. 1 This review presents an overview of the current status of this topical debate.

Definition and current legal framework

Assisted dying is a general term that incorporates both physician-assisted dying and voluntary active euthanasia . Voluntary active euthanasia includes a physician (or third person) intentionally ending a person’s life normally through the administration of drugs, at that person’s voluntary and competent request. 2 , 3 Facilitating a person’s death without their prior consent incorporates both non-voluntary euthanasia (when the patient is not capable of providing informed consent, e.g. vegetative state, young child) and involuntary euthanasia (against patient’s will). Physician-assisted dying is defined as follows: a physician intentionally helping a person to terminate their life by providing drugs for self-administration, at that person’s voluntary and competent request. 2 , 3 Consequently, in the first case a third person acts resulting in patient’s death, whereas in physician-assisted dying the action is undertaken by the patient who is given lethal medication by a physician. 2

Discussion regarding withholding or withdrawing treatment and requesting assisted death has emerged in association with the simultaneous expansion of palliative care across the world. The World Health Organization defines palliative care is an approach that

improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. 4

It intends to neither hasten nor postpone death. Nonetheless, in practice, terminally ill patients – often with full mental capacity – may develop a loss of self-determination as their condition deteriorates and express a desire for assisted dying to alleviate intractable physical symptoms.

Assisted dying is an emotionally and ethically challenging subject, which understandably receives varying degrees of acceptance among different global jurisdictions. Currently, there is legal provision for assisted dying (or variants) in only four European countries (the Netherlands, Belgium, Switzerland and Luxemburg), Canada, Colombia and the United States of America (USA) states of Oregon, Washington, Montana, Vermont, California, Colorado and Washington, DC, representing nearly 18% of the US population. 5 , 6 Switzerland is the only country which permits the act of assisted dying performed by a non-physician. Moreover, non-Swiss citizens can exploit the Swiss law by visiting Switzerland in order to access assisted dying. 7 In these more tolerant jurisdictions, palliative care is seen as an important link in the same chain as assisted dying in caring for terminally ill individuals, rather than an alternative. Elsewhere in the world, an assisted death remains a criminal offence, prosecutable through various legal routes. For example, in the UK, all forms of assisted dying remain illegal and can be considered under criminal laws of manslaughter or murder, or under the Suicide Act (1961), depending on the circumstances. 6 Prosecution guidelines were first issued by the Director of Public Prosecutions in 2009 following House of Lords ruling in the case of Debbie Purdy, which stated that there was ambiguous guidance regarding when people would be prosecuted for encouraging or assisting suicide. The guidelines suggest that while each case will be assessed on its relative merits, individuals acting in the capacity of a healthcare professional are more likely to be prosecuted for assisting or encouraging suicide, although to date no report-providing doctor or accompanying individual has been prosecuted for helping patients to travel abroad from the UK to end their life. 8 In England and Scotland, three assisted dying bills have been proposed and debated, largely based on the Oregon Death with Dignity Act (1997) from the USA, which permits assisted dying; none were passed.

We performed a systematic search of MEDLINE and EMBASE databases from conception to January 2018. The search terms used were ‘euthanasia’, ‘assisted dying OR death’, ‘assisted suicide’, ‘medical ethics’, ‘autonomy’, ‘end of life’ and ‘sanctity of life’. We also combined free text searching with Medical Subject Headings (MeSH) terms and no restrictions were set in publication date, study design and publication status.

Principles of bioethics

Autonomy and right to life.

Beauchamp and Childress developed a standard approach to bioethics and advocated for four principles that lie at the heart of healthcare ethics and underpin decision-making. 9 , 10 Respect for autonomy is one of the fundamental concepts, in combination with justice , beneficence and non-maleficence .

In medical practice, autonomy describes the right of competent adults to make informed decisions about their own medical care, prior to any investigation or treatment taking place. For a physician, respect for autonomy includes acknowledging and preserving a patient’s right to self-determination and providing the necessary guidance, which would allow for an informed and independent choice, free of coercion.

However, autonomy is far from a straightforward consideration. Onora O'Neill, in an attempt to scrutinise the context of autonomy in her Gifford lectures, makes a clear and compelling distinction between the approach of John Stuart Mill and Kant regarding the subject of autonomy. 11 As O’Neill vividly describes, Mill stretches the bound of choice and ‘sees individuals not merely as choosing to implement whatever desires they happen to have at a given moment, but as taking charge of those desires, as reflecting on and selecting among them in distinctive ways’. 11 The Kantian version of autonomy is guided by a ‘practical reason’. Kant views autonomy as ‘a matter of acting on certain sorts of principles, and specifically on principles of obligation’ rather than a form of self-expression and supports that ‘there can be no possibility of freedom for any one individual if that person acts without reference to all other moral agents’. 12 O’Neill embraces the Kantian view and contextualises it as ‘principled autonomy’ compared to ‘individualistic autonomy’. O’Neill’s work vigorously illustrates the fragility of the concept of autonomy and its contingency on a number of other considerations, particularly the network of human relationships within which it features.

The greatest expression of autonomous self-determination is the right of ‘capacitous’ adults to refuse any proposed intervention (irrespective of rationality), even if this decision could result in harm or death, provided they are capable of freely reaching a decision in the above manner. For this reason, obtaining informed consent from a patient after they have been offered all the relevant information regarding their situation is of paramount importance. During the past decades, the development of liberal democracies has highlighted the significance of self-determination, with healthcare systems increasingly adopting more patient-centred approaches to care decisions. The right to bodily autonomy has also been enshrined under Article 8 ( Table 1 ) of the European Convention on Human Rights (ECHR).

Article 8: Right to respect for private and family life.

Taking the above into consideration, Article 8 encompasses inter alia the right to personal development. In a technical legal sense within the jurisdiction of Swiss law, it includes a patient’s choice to avoid what they consider an undignified and severe end to their life. 14 Proponents of this highly contentious argument claim that seriously ill patients should have a choice in whether or not they wish to continue living with a condition that undermines their inherent dignity and personal identity, 15 without violating the principle of sanctity of life. Therefore, it can be argued that respecting autonomy inherently involves the prima facie right of a patient to control the circumstances and time of death by requesting help in dying. This could minimise the suffering of an individual or their family and improve the quality of the end of the patient’s life, as their wishes would be respected and dignity would be preserved. 16 , 17

A further dimension that can be considered is the treating clinician’s ethical beliefs and values. During their training, most practising clinicians have not experienced the concept of assisted dying as an expected duty in the context of patients’ autonomy. 18 Nevertheless, it is important to consider the magnitude of patients’ autonomy within modern society. Individual liberty ought not to be viewed as absolute and exceptions to Article 8 should be provided in favour of preservation and reverence to life. 17 , 18

The right to life is guaranteed by Article 2 ( Table 2 ) of the European Convention on Human Rights. Under Article 2, the State is enjoined to abstain from the deliberate and illicit taking of life, as well as to protect vulnerable people against actions by which they could jeopardise their lives. The principle of sanctity of life emerges frequently in modern discussion, particularly in Anglo-American bioethics, surrounding public controversy about end of life and abortion issues. Yet, its moral foundation is rarely unriddled and understood. The sanctity of life position asserts that life has sanctity and its value prevails all other values. No individual’s life deserves priority, and sanctity is attributed to life regardless of the physiological status, imminence of death, suffering or individual’s wishes to live or die. 19

Article 2: Right to life.

This argument is often associated, but not fully equated, with religious and cultural traditions that generally object to assisted death, because human life is viewed as God’s sovereign creation. From a religious perspective, God is considered the only one who can determine the beginning and end of human life. The sanctity of life is a value also clearly mirrored under Article 9 of the European Convention on Human Rights, which refers to freedom of thought, conscience and religion. 13 It is notable, though, that Article 2 does not encompass assisted dying, i.e. in situations where a person’s decision to end their life has been taken independently and with absolute perception of what it implied.

The crucial issue is therefore one of balance . Patient autonomy has to be balanced against the principle of sanctity of life. It should be acknowledged though that the autonomy argument is secondary in its applicability on whether assisted dying is ethically permissible and cannot solely guide decisions on what is morally impermissible, as it constitutes only a piece of the puzzle. The right to end a life that an individual finds intolerable has to be considered in association with its resulting impact on other rights, regulations and the responsibilities of healthcare professionals in facilitating assisted dying. 18

As discussed, justice constitutes one of the main four fundamental principles of medical ethics. All individuals in a society should be treated equally and impartially. One of the arguments that has monopolised the debate concerning assisted dying is the ‘slippery slope’. According to this, should assisted suicide be established, then it might be applied in circumstances that fall outside the scope of morally permissible cases, such as in patients who may not be fully competent. 17 Furthermore, if a person is motivated by means other than his own will, for example through external coercion, then patient autonomy is infringed.

In this regard, concerns are raised about vulnerable populations, such as the terminally ill, the mentally incapacitated and the elderly. There remains the understandable fear that assisted dying could potentially lead society toward an attitude that suffering should not be a part of life, interdependency is a burden and the lives of disabled of terminally ill individuals are not worth living. 20 The implications of such an attitude on vulnerable populations is clear, with individuals potentially forced or coerced into assisted dying for reasons other than their own free will.

The slippery slope argument is inordinately complex and controversial evidence exists in the literature in favour of both sides. Cases of assisted dying in the Netherlands grew from 1882 in 2002 to 5306 in 2014. 21 Eight-one cases were concerned with dementia and 41 with mental health-related reasons only in 2014. 6 In the light of data from Holland, the slippery slope argument is supported in a number of respects, e.g. concerns about legislation ‘creep’, lack of availability of good palliative care and fears in the vulnerable and elderly. Early data published from Oregon were also concordant. The number of physician-assisted deaths progressively rose from 16 in 1998 to 71 during 2011; loss of autonomy (88.7%) and ability to participate in enjoyable activities (90.1%) were the two most commonly reported end-of life concerns. 22 In increasingly financially constrained health and social care systems, fears have also been raised regarding the impact of budget-cutting trends and their potential impact on terminally ill individuals for whom the alternatives are only high-cost life-prolonging or quality-enhancing (rather than curative) treatments.

However, recent data summarising the 20 years’ experience in Oregon suggest the opposite. According to the authors, patients requesting an assisted death allegedly belong to a higher than average socioeconomic class and have a higher than average education level. 23 Oregon, the first state in the US to allow assisted dying, employed strict criteria that had an influential role in other jurisdictions. 5 The criteria comprised the agreement of another doctor, the assessment of the patient’s mental capacity and the presence of a terminal illness with less than six months to live. 24 Additional measures to ensure an informed and unforced decision involved adequate pain relief and access to end-of-life care. 25 Assisted dying proponents support that safeguards and regulations in place are very powerful since only one in 50 terminally ill patients have a discussion about the process with their doctor and even fewer complete it. 26

Rhetoric from opponents has raised concerns of whether such safeguards could ever be adequate, which appears to be a key argument in the debate in some jurisdictions as well. Consequently, any future legal permissibility of assisted dying should be developed in conjunction with clear regulatory safeguards to ensure the abuse of assisted dying and protect vulnerable individuals from coercion. 3 . Such safeguards must also preserve societal justice and ensure equitability and availability of healthcare is not a deciding factor in assisted dying decision-making.

The Hippocratic Oath and the principles of beneficence and non-maleficence

The principles of beneficence and non-maleficence , plainly described in the Hippocratic Oath, have been the foundation of medical ethics for many centuries. Beneficence states that a doctor should act in the best interest of the patient. Non-maleficence states ‘first, do no harm’ – ‘ primum non nocere ’. 27 Conformation to these fundamental principles is enshrined within Hippocratic Oath, which involve aiming to benefit, or perhaps most importantly, not doing any harm to a patient. Moreover, modern medical education in most countries follows legal and cultural opposition to an assisted death. Healthcare professionals are therefore currently not adequately trained to participate in assisted dying. Professional opinion also remains divided on whether further involvement would benefit or damage public perception of the profession, given the potential conflict between these two ethical principles. The UK’s medical representative body, the British Medical Association (BMA), has acknowledged this lack of consensus, but clearly concludes with their view that assisted dying should not be made legal in the UK. 28

However, the evolution of decision-making processes in modern medicine, particularly regarding end-of-life decisions, and with patients increasingly at the heart of shared decision-making (e.g. the UK NHS’ ‘no decision about me, without me’ policy), have applied pressure on clinicians to reconsider their collective professional stance on assisted dying. Indeed, an increasing number of legal challenges from patients and assisted dying representative organisations are taking place worldwide to challenge local legislation against an assisted death.

Assisted dying therefore challenges the conflict faced between the ultimate purpose of modern medical and social care and its founding ethical principles. Relief of suffering through an assisted death can be argued as a distinct entity to palliative care, with the former – if safely and carefully considered – potentially an important way of fulfilling a clinician’s duty to preserve autonomy and do good for a patient – for example, in cases where alternatives are treatments which provide no benefit or do not prolong or improve the quality of life of a terminally ill patient. 27 , 29 A further consideration is that of an individual doctor’s ethical and moral beliefs, which are also an important factor should a patient request an assisted death; indeed, the British Medical Association has proposed that should assisted dying legislation be derived, then there should be a clear demarcation between those physicians who do and do not offer this option. 30

Freedom of thought, conscience and religion

A further controversial issue is raised by Article 9 of the European Convention on Human Rights, which protects the rights of freedom of thought, conscience and religion. Its impact on the assisted dying debate centres on whether requesting an assisted, dignified death constitutes a manifestation of belief, therefore falling within the remit of Article 9. Several European Court decisions have determined that individual views are entitled to protection only if they ‘attain a certain level of cogency, seriousness, cohesion and importance’. 31

Seriousness and importance are undoubtedly justified when considering an individual’s decision to end their life. On the other hand, an informed desire to die with dignity may well constitute a coherent and cogent view. For instance, it remains debatable whether approaching death through a solely palliative care lens constitutes a less dignified way to die than assisted dying. 31 Article 9 may therefore provide a preferable framework for decisions relating to the right to die with dignity than Article 8, which focuses on a patients’ autonomy; while the former aims to protect truly coherent and cogent decisions, it may be argued that the latter in isolation could potentially open a bigger door to a broader attitude towards assisted dying. 13

Furthermore, Article 3 should also be considered as a safeguard, as this prohibits torture and degrading treatment. 17 Ultimately, each potential assisted dying case is unique and its various facets should therefore be approached carefully under the scope of relevant legislation (e.g. European Convention on Human Rights Articles 2, 3, 8 and 9), and individual/societal ethical and moral perspectives ( Tables 1 ​ 1 ​ to ​ to4 4 ).

Article 3: Prohibition of torture.

Article 9: Freedom of thought, conscience and religion.

Implications of assisted dying in the doctor–patient relationship

As discussed, a key concern of the medical profession remains the impact of legalisation of assisted dying on the doctor–patient relationship. This relationship is fundamentally based on trust. Although aspects of assisted dying may be considered in conflict with certain underlying ethical obligations placed upon doctors, considering a patient’s autonomous wishes, alongside the moral perspectives of the doctor, is also an important aspect of this relationship. 32 , 33 This quandary is recognised by the Swiss Academy of Medical Sciences in their ethical guidelines, which acknowledges that ‘in certain special cases a doctor’s personal decision to assist a dying patient to commit suicide is in accordance with his or her conscience and has to be respected’. 18

The delicate balance between the views of patients, doctors and society can pose an ethical dilemma, with the potential to serve a disruptive influence on the sanctity of the doctor–patient relationship and negatively distorting how society perceives the role and motives of healthcare professionals. For example, as previously considered, particularly in healthcare systems where doctors play the role of gatekeeper to healthcare, a doctor’s support for an assisted death for a terminally ill individual might be negatively interpreted as a conflict of interest, with a desire to help relieve the social and economic burden of a patient’s illness upon society overriding the patient’s individual interests. Ultimately, should appropriate safeguarding measures be deployed alongside relevant legislation, assisted dying may risk eroding doctors’ professional integrity. 34

Current position of doctors’ professional groups in the UK and the USA

As expected, the discussion around adopting assisted dying has caused much controversy among the doctors’ professional groups and bodies. Several professional organisations in the UK have clearly expressed their opposing views to assisted dying such as the British Medical Association, the Royal College of General Practitioners and the Royal College of Surgeons of England, whereas others maintain a neutral position including the Royal College of Nursing, the Royal College of Psychiatrists and the Royal Pharmaceutical Society. 5 The Royal Society of Medicine has no policy on the issue since ‘its remit is the education of doctors and health professionals and the promotion of debate, not the making of policy’. 35

In the US, the American Medical Association, representing nearly 250,000 members, vehemently opposes legalisation of assisted dying as does the American College of Physicians with more than 150,000 members. 6

Conclusions

The debate surrounding assisted dying is never far from the headlines, particularly while its legal status in most jurisdictions remains inadequate and discursive. However, alongside the evolution of palliative care, there appears to be an increasingly vocal desire for legislation to support assisted dying in selected cases. 21 Developing a sensitive balance between established cultural norms and a progressive, well-balanced, transparent and safe attitude towards assisted dying is key. 24 More patient-centred attitudes towards health and social care increasingly place patients – quite rightly – at the heart of everything health professionals do. Patients’ needs, attitudes and beliefs must be therefore at the forefront of decision-making. However, when considering these alongside the fundamental principles of bioethics as well as legislation and doctors’ own beliefs, conflict can arise, thereby leaving the assisted dying debate in a state of limbo. Whether assisted dying should be legalised (albeit with stringent controls) remains controversial; as considered in this essay, even the basic moral principles can conflict when considering the arguments for and against supporting an assisted death, making consensus building far from straightforward.

Ultimately, individual patients’ autonomy should be balanced with a fundamental right to life, impacts on the individual doctor–patient relationship and wider society and the safeguards required to prevent misuse of any assisted dying regulations. The challenge remains for society to decide where this balance lies, guided by regional religious, cultural and legislative perspectives.

Developing the required ethical competencies among medical professionals is also key; given the current absence of legal support for assisted dying in most jurisdictions, most clinicians remain untrained in such decision-making. Indeed with understandable fears against crossing key ethical divides, physician support for an assisted death tends to be lower than that of patients. 36 Dying is a natural part of human life. With growing demand worldwide, the assisted dying debate will increasingly come to the fore – something healthcare professionals, politicians and legislators cannot ignore.

Declarations

Competing interests.

None declared.

Ethics approval

Ethics approval was not required for this review.

Contributorship

AF and EP conceived, designed the study and performed the literature search. All authors analysed the data and drafted the manuscript. All authors contributed to and approved the final version of the manuscript.

Acknowledgements

Not commissioned; peer-reviewed by David Misselbrook.

The Ethical and Legal Implications of Euthanasia

Generally, the topic of euthanasia has resulted in hot debates among all stakeholders, including healthcare professionals and legal experts, due to the ethical and legal issues associated with the topic. It affects both patients and their healthcare providers. Over the years, the debate on euthanasia has focused on suffering patients with terminal illnesses. However, the topic has extended to include even patients with mental illnesses like depression. Therefore, it is appropriate to look at the controversy surrounding euthanasia in a recent case study. Euthanasia is a controversial topic that requires further inquiry to fully understand different opinions offered by the opposing sides and the ethical implications associated with it.

Recent Case Study

The case published in the Catholic Herald involves a 29-year-old woman who underwent euthanasia following a series of mental illnesses. According to the author, despite being physically fit, the woman was given a lethal injection, having been granted her wish to die by the court after eight years of legal battles. In her argument, the woman claimed she had experienced extreme bouts of depression that had made her life intolerable. The case raised concerns among various stakeholders, including politicians who lamented how dangerous euthanasia could be.

Ethical Issues Involved in the Case Study

Generally, the case study raises various ethical dilemmas related to euthanasia, including when it is justifiable to end one’s life. In addition, the topic also opens up a whole discussion on the limitations of patients’ autonomy and the ethical responsibilities of healthcare professionals, as highlighted in the bioethical principles of beneficence and maleficence. Concerning autonomy, questions are raised regarding the patient’s capability to understand the decision that she was making. With superior knowledge and training, the physician is best positioned to help make an ethical decision that is in the patient’s best interest to protect patients from irresponsible choices. For patients to make an autonomous decision, they should be mentally capable of comprehending the information of the decision. In the case study, the patient has a mental health condition. Hence, her ability to make rational decisions is in question.

The Context of Euthanasia

The case study highlights euthanasia, particularly among patients with mental conditions such as depression. Historically, numerous attempts have been made to legalize euthanasia, but minimal success has occurred. The euthanasia discussion in psychiatry was awakened after the Nazi Holocaust when thousands of psychiatric patients were gassed or poisoned to death under the ‘euthanasia program’. According to Felder, the Nazi euthanasia program was used by scientists, mainly physicians, to conduct medical experiments. It is out of the scientific experiments of the Nazi physicians that ‘The Nuremberg Code’ was established to guide future experiments on human subjects.

Additionally, politicians have had their hand in the matter by sponsoring bills to legalize the act, with some opposing such attempts and publicly making their views known. From a social perspective, euthanasia has continued to be controversial, with many societies coming up to air their opinion. In the traditional Christian context and culture, euthanasia is viewed as morally unacceptable due to human life’s sacred nature. However, other social groups support euthanasia with the thought of extending dignity to death, such as the Voluntary Euthanasia Society. As such, there is no single available societal perspective regarding the issue of euthanasia. Hence, it is important to society as it touches on the critical matters of life and death.

The Differing Perspectives on Euthanasia

The individuals and societies in support of euthanasia have always centered their opinion on patient suffering. They argue that patients in the terminal stages of illness experience excruciating pain and have poor wound healing, poor social interactions, and many other aspects of physical suffering. According to the proponents, euthanasia is a more merciful response to relieve this suffering, especially where the quality of life is jeopardized. Among the patients with mental illnesses, the proponents argue that some mental conditions, including severe depression, induce intense suffering and are unresponsive to treatment. Additionally, the proponents note that since the patients request most cases of euthanasia, it is a way for physicians to show respect for personal autonomy. Thus, to the proponents, euthanasia relieves undue suffering and is in harmony with respect for autonomy and the individual’s right to a dignified death.

Contrary to the proponents’ arguments, the opponents base their argument on the intrinsic wrongness of killing, professional integrity, and the possibility of potential abuse. According to Naga and Mrayyan, willingly ending one’s life is inconsistent with human rights, and alternatives should be sought to relieve the patient’s suffering and improve their quality of life. Furthermore, Naga and Mrayyan note that administering lethal substances by physicians to end life is unethical according to guiding medical ethical practices, especially the Hippocratic Oath that restricts physicians from administering such substances to their patients or aiding their patients to die. They also note that legalizing euthanasia could lead to its potential abuse and a slippery slope where individuals will use it to escape chronic but manageable medical conditions.

Evaluation of the Arguments and Their Ethical Implications

The arguments presented by both the proponents and the opponents seem to be entirely influenced by one’s culture, moral philosophy, and personal experiences. Those opposed to euthanasia seem to be influenced by their religious cultures. Specifically, Christian teachings view life as sacred and state it should not be terminated prematurely at any cost. On the other hand, the proponents seem to subscribe to the Stoic philosophy that has always defended suicide as a reasonable departure from life, especially when intense suffering is involved. Anecdotal evidence also suggests that personal life experiences with suffering may make one choose to end one’s life. For example, seeing a cancer patient suffer may make individuals consider euthanasia if diagnosed with a similar terminal disease, as they will not want to experience the same ordeal.

While both the proponents and those opposed to euthanasia have valid arguments, myriads of ethical issues surround each side’s perspective. It is indeed true that certain illnesses, including mental conditions, lead to severe suffering and reduced quality of life. However, ethical issues arise regarding the ability of the patients requesting euthanasia to make autonomous decisions. For example, Appelbaum notes that it is common for depressed patients to reject treatment and even request death, yet change their decision once the depression is resolved. Accordingly, this raises the ethical question concerning the impact of the mental illness itself on the patient’s decision-making. It has also been observed that most patients are only resistant to one form of treatment and that other options should be tried to relieve their suffering.

Furthermore, it is noted that the right to autonomy is not always absolute and that physicians have the legal and ethical responsibility to override the patient’s decisions and continue pursuing alternative treatment in response to the patient’s symptoms and request a dignified death. Thus, the argument regarding patients’ autonomy to end their lives is weak. On the other hand, the opponents’ unethical medical practice mainly touches on physicians’ ethical responsibilities to act in good faith and protect their patients from harm. In line with non-maleficence and beneficence principles, physicians cannot administer lethal dosages to their patients as it causes more harm than good. Additionally, the claim of potential abuse if euthanasia is legalized, holds grounds owing to several reported cases, including ones with mental illnesses, where euthanasia has been performed without following due process in countries where it is legalized. Thus, the ethical questions raised by those opposed to euthanasia regarding non-maleficence, benevolence, and potential abuse are strongly supported by evidence.

Personal Perspective on Euthanasia

The issue of euthanasia among depressed patients will continue to dominate medical discussions. Subjectively, the opponents of euthanasia seem to offer a strong argument. Notably, depression can be treated just like other mental conditions, and symptoms can be controlled where treatment is impossible. Patient autonomy among psychiatric patients is in question. Mental illnesses tend to affect one’s way of thinking, and suicidal ideations are common phenomena among depressed patients. I have dealt with patients who have changed their stance on ‘mercy killing’ after a series of professional counseling sessions and continued treatment. Thinking about these experiences concerning my patients and the ethical dilemmas related to euthanasia makes me view it as an undesirable event in medical practice that I will not want to engage in.

The topic of euthanasia is controversial based on the numerous arguments aired by those in its support and those who are against it. The case study published in the Catholic Herald offers a good scenario through which the effects of euthanasia can be accessed and its ethical implications reviewed. While the Pro-euthanasia argument is based on the need to relieve undue suffering, respect autonomy, and grant the right to a dignified death, the opponents have emphasized the intrinsic wrongness of killing, professional integrity, and the possibility of a “slippery slope”. Overall, the ethical issues addressed autonomy, beneficence, and non-maleficence. Subjectively, the ethical questions touching upon professional integrity, especially the need to observe non-maleficence and doing good, are strong enough to make me offer my support against euthanasia.

📎 References:

1. Appelbaum, P. S. (2017). Should mental disorders be a basis for physician-assisted death? Law & Psychiatry, 68(4), 315-317. https://doi.org/10.1176/appi.ps.201700013 2. Beauchamp, T. L. (2016) Principlism in bioethics. In P. Serna & J. A. Seoane (Eds.), Bioethical decision making and argumentation (pp. 1-16). New York, NY: Springer. 3. Caldwell, S. (2018, February 1). Dutch doctors euthanize a 29-year old woman with depression. Catholic Herald. 4. Felder, B. M. (2013). “Euthanasia,” human experiments, and psychiatry in Nazi-occupied Lithuania, 1941-1944. Holocaust and Genocide Studies, 27(2), 242-275. https://doi.org/10.1093/hgs/dct025 5. Kim, S. Y., De Vries, R. G., & Peteet, J. R. (2016). Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014. JAMA Psychiatry, 73(4), 362-368. https://doi.org/10.1001/jamapsychiatry.2015.2887 6. Naga, B. S. B., & Mrayyan, M. T. (2013). Legal and ethical issues of euthanasia: Argumentative essay. Middle East Journal of Nursing, 7(5), 31-39. https://doi.org/10.5742/MEJN.2013.75330 7. Nunes R., & Rego, G. (2016.) Euthanasia: A challenge to medical ethics. Journal of Clinical Research & Bioethics, 7(4), 1-5. https://doi.org/10.4172/2155-9627.1000282 8. Tomasini, F. (2014). Stoic defence of physician-assisted suicide. Acta Bioethica, 20(1), 99-108. Retrieved from https://scielo.conicyt.cl/pdf/abioeth/v20n1/art11.pdf

Table of content

Crafted with Care:

Nursing Essays!

Precision, Passion, & Professionalism in Every Page.

Home — Essay Samples — Social Issues — Euthanasia — For Euthanasia: A Moral and Ethical Debate

For Euthanasia: a Moral and Ethical Debate

• Categories: Assisted Suicide Euthanasia

About this sample

Words: 694 |

Published: Sep 7, 2023

Words: 694 | Pages: 2 | 4 min read

Table of contents

Relief from suffering, respect for individual autonomy, compassion and empathy.

Cite this Essay

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Prof. Kifaru

Verified writer

• Expert in: Social Issues

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

3 pages / 1552 words

4 pages / 1865 words

3 pages / 1154 words

5 pages / 2332 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Euthanasia

Euthanasia, the practice of ending the life of a suffering patient through the use of barbiturate or paralytic injections, remains a highly controversial medical procedure. While it is legal in the majority of European Union [...]

Euthanasia, also known as mercy killing, is the act of intentionally ending a person's life to relieve their suffering. This controversial topic has been the subject of much debate and ethical consideration in the medical and [...]

Darren, Sweeper. "Euthanasia - Pros and Cons of Mercy Killing." (n.d.). 2010. Web. "Definition of Euthanasia." 1998. Web. Fletcher, Joseph. "The Courts and Euthanasia." Law, Medicine & Health Care 15.4 (1987/1988): 223-230. [...]

Euthanasia, also known as mercy killing, is the act of intentionally ending a person's life to relieve them from suffering. Voluntary euthanasia is when an individual makes a conscious decision to end their life with the [...]

Imagine facing a terminal illness with no hope for recovery, only prolonged suffering and pain. In such situations, the concept of euthanasia, or assisted suicide, becomes a controversial but increasingly relevant topic. [...]

Battin, M. P., Rhodes, R., & Silvers, A. (2015). The Patient as Victim and Vector: Can Ethics Abandon the Ideal of the Autonomous Patient? The American Journal of Bioethics, 15(3), 3-14.Pereira, J. M. (2011). Legalizing [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

The Ethics of Euthanasia

Malleeka Suy | SQ Blogger | SQ Online (2021-2022)

Picture t his: It is the year 3020, and the Martian soil you have been drilling into has finally worked out. Colonizing Mars is taking shape, and soon your family can permanently live on this rusty, rocky planet. However, the effects of progress don’t go unnoticed; every time you move, your skin screams in pain. Everything you once loved doing has lost its appeal. Would you take death in your own hands or live until a painful end?

This moral dilemma seems straight out of a science-fiction novel for most, but euthanasia is a legitimate deliberation for patients with terminal and mental illnesses who deem their lives too painful to live on. It is a practice that is still heavily debated in modern bioethics. Among many definitions, the American Medical Association defines euthanasia as the administration of a lethal agent by a medical professional to a patient to relieve their intolerable or incurable suffering.

Although euthanasia is not a new scientific process, as it has been practiced since the time of the ancient Greeks more than three thousand years ago, it wasn’t generally accepted by Western medicine until recently. The Netherlands was the first country to allow legal euthanasia and assisted suicide in 2002, totaling 1.7-2.8% of total deaths. Euthanasia is generally illegal in the United States, but in a nationwide 2017 American poll , 73% of the public were in favor of euthanasia, and 57% said euthanasia is morally acceptable. These numbers are nearly double the initial poll in 1947. If I had to guess why, it may be partly because of progressive exposure to mental health and its effects. This may have allowed people to understand and empathize with the circumstances and support what euthanasia stands for: a release from an unbearable life.

Euthanasia is especially controversial among general society and the bioethical community. One main argument for the support of euthanasia is grounded in personal autonomy–our ability to act independently– since living life is about minimizing physical pain and maximizing dignity and control . This idea is rooted in ancient times when physicians considered dying with peace and dignity a human right. An article from Stanford’s Encyclopedia of Philosophy regards autonomy as self-determination, so choices about how and when people die is them taking responsibility for their lives. Terminally ill patients in Oregon mentioned how they chose euthanasia because their condition stripped them of their independence and ability to engage in activities that gave their life meaning. After all, what is the meaning of life if we cannot live it?

Another article by the Linacre Quarterly highlights how the ethics of compassion justify the use of euthanasia. From a humanitarian standpoint, we can show compassion by suffering and sympathizing with patients and respecting their wishes of euthanasia as their “remedy.” Kenneth L. Vaux, a consultant in medical ethics, notes in his article that physicians would give a lethal dose to their loved ones out of love if they were dying and suffering, so he finds it “strange and hypocritical” that doctors cannot legally do so for their patients. He claims that “we have lost empathy, sympathy, and the covenant of care with those who have entrusted their lives to us because they believe we embody those very qualities.” Vaux also asks: “Having barred the door to Death, are we not then obliged at some point to open it?” He suggests that since doctors bring life into the world every day, consensually ending a patient’s life for their benefit should be no different.

Despite popular social support, there are many arguments against euthanasia as well–the most popular being religion. Several faiths, such as Christianity, see euthanasia as a form of murder and find it to be morally unacceptable because it may weaken society’s respect for the sanctity of life. Religious groups actively argue against euthanasia, and for this reason, euthanasia became a debate of preservation and purity of life.

Even though medicine is rooted in science, some physicians also use religion as justification against practicing euthanasia. Contrary to public British opinion, studies show that most UK doctors do not support legislation permitting euthanasia due to their religiosity or faith, and less than a quarter of doctors would be willing to practice euthanasia if it became legal.

Physicians also have a professional obligation to fulfill that becomes morally blurred with euthanasia. For more than 2,500 years, doctors have taken the Hippocratic Oath to do no harm and treat those under their care. Does bringing death by euthanasia violate the Hippocratic Oath, or is it in line with a doctor’s mission? Would acting under Hippocrates then make a doctor a hypocrite?

Because of this subjectivity, doctors sometimes feel uncertain about administering euthanasia. Even if a patient is under a lot of pain and medication, how can doctors be sure that their decision was made rationally? In a Dutch article , an experienced psychiatrist dealing with a patient’s invisible suffering made him uncertain about assessing how deeply rooted their suffering really was, and therefore how moral it would be to allow euthanasia to happen. The fickle nature of the human mind makes many physicians and ethicists question whether or not euthanasia should be a normal practice.

Physicians often have their own reservations about euthanasia and how they cope with patients who wish for it. They frequently feel pressured by the patient or the patient’s relatives to perform euthanasia. A 2011 survey among Dutch physicians also found that 86% of physicians dread the emotional burden of performing euthanasia. One physician recounts how a patient told them, “If you won’t perform euthanasia, I might go to a railway line or climb a high building.” This form of blackmail can lead to dangerous expectations, where future normativity of the practice is anticipated or even praised.

Instead of placing the burden on doctors, what if the government or even robots could control euthanasia? Although this faceless jurisdiction seems like a good solution, critics argue that euthanasia would be normalized and twisted for eugenic purposes, adding to the nightmare of AI domination and impeding the sanctity and preciousness of life. These speculations seem inconceivable, but history has unfortunately seen it happen, such as in Hitler’s Germany, where Aktion T4, a Euthanasia Program systematically murdered patients with disabilities to restore the “integrity” of the German nation, thrived. Perhaps then a grimmer alternative to the use of euthanasia is the elimination of incurable, disabled, or elderly patients. Mechanization of euthanasia would also impact the patient and the medical profession, both in what it means to be human and obeying the Hippocratic Oath. Routinization of the practice could also increase the desires of people’s wishes to end their lives, whether individually justified or not.

References:

https://jamanetwork.com/journals/jama/article-abstract/2532018

https://plato.stanford.edu/entries/euthanasia-voluntary/#MoraCaseForVoluEuth

http://www.cirugiaycirujanos.com/frame_esp.php?id=308

https://www.sciencedirect.com/science/article/pii/S0885392414003066?via%3Dihub

https://www.healthline.com/health/what-is-euthanasia#making-a-decision

https://livinganddyingwell.org.uk/wp-content/uploads/2020/02/Redefining-Physicians-Role-in-Assisted-Dying.pdf

https://shibbolethsp.jstor.org/start?entityID=urn%3Amace%3Aincommon%3Aucsd.edu&dest=

https://www.jstor.org/stable/3561966&site=jstor

https://doi.org/10.1177%2F0269216310397688

https://www.medicalnewstoday.com/articles/182951#some-statistics

https://journals.sagepub.com/doi/10.1177/0269216310397688

https://www.nejm.org/doi/10.1056/NEJMclde1310667

https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/euthanasia

https://news.gallup.com/poll/211928/majority-americans-remain-supportive-euthanasia.aspx

https://www.ama-assn.org/delivering-care/ethics/euthanasia

https://pubmed.ncbi.nlm.nih.gov/21145197/

https://doi.org/10.1016/j.jpainsymman.2014.04.016

https://www.ccsenet.org/journal/index.php/gjhs/article/view/19405/13366

https://encyclopedia.ushmm.org/content/en/article/euthanasia-program

Home / Essay Samples / Health / Euthanasia / Ethical Dilemmas in Euthanasia: Balancing Autonomy and Compassion

Ethical Dilemmas in Euthanasia: Balancing Autonomy and Compassion

• Category: Life , Health
• Topic: Ethical Dilemma , Euthanasia

Pages: 3 (1544 words)

• Downloads: -->

--> ⚠️ Remember: This essay was written and uploaded by an--> click here.

Found a great essay sample but want a unique one?

are ready to help you with your essay

You won’t be charged yet!

Assisted Suicide Essays

Drug Addiction Essays

Alcohol Abuse Essays

Smoking Essays

Underage Drinking Essays

Related Essays

We are glad that you like it, but you cannot copy from our website. Just insert your email and this sample will be sent to you.

By clicking “Send”, you agree to our Terms of service  and  Privacy statement . We will occasionally send you account related emails.

Your essay sample has been sent.

In fact, there is a way to get an original essay! Turn to our writers and order a plagiarism-free paper.

samplius.com uses cookies to offer you the best service possible.By continuing we’ll assume you board with our cookie policy .--> -->