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 Should assisted suicide be legalised in Scotland? 
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Joined: July 5th, 2007, 8:43 am
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A bit of a read, but thought I would share... Below is an essay that I wrote for my Moral Philosophy class last semester. Looking back there are things in there that I would change as some assertions are probably a bit naive (the bit about family not taking advantage for example), but the essay lays out in philosohical terms why I support assisted dying and (in some cases) even euthansia.

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. . . death is nothing to us. For all good and evil consists in sensation, but death is deprivation of sensation. And therefore a right understanding that death is nothing to us makes the mortality of life enjoyable, not because it adds to it an infinite span of time, but because it takes away the craving for immortality. For there is nothing terrible in life for the man who has truly comprehended that there is nothing terrible in not living. [Death] does not then concern either the living or the dead, since for the former it is not, and the latter are no more. Epicurus (Bailey 1926, pp. 124–125)




To establish whether euthanasia is morally permissible under certain circumstances, I shall examine the question in two ways. I will review the deontological arguments which view the act of euthanasia itself as intrinsically wrong. I will continue by looking at some of the consequentialist arguments against euthanasia – in particular utilitarian views which seek to establish whether a case can be made to allow euthanasia in certain circumstances when the overall benefits of the act outweigh the overall costs to society. I will examine in detail the premises behind each of these viewpoints in order to evaluate the conclusions that each draws as a result and finally I will discuss my personal opinion that euthanasia can be morally permissible in certain circumstances and lay out the reasons why I have formulated that opinion.

Firstly I will more fully define what I mean by the term ‘euthanasia’. My first assertion is that “Euthanasia” differs from other types of killing in that the motivation behind the killing centres on a concern for the person being killed – that is, that euthanasia is not carried out against the person’s wishes (involuntary euthanasia). Where there has been no explicit expression by the individual against euthanasia as an option, there remains two possibilities related to who makes the decision and two ways in which the act may be carried out. An individual may request that they are killed – “voluntary euthanasia” or, if they are incapable of making a rational decision (for example a new-born infant or someone suffering a severe mental disablement) then that decision could be made by a proxy – “non-voluntary euthanasia”. The act itself can be “passive” - by withdrawing treatment and allowing nature to take its course or it could be “active” - where death is hastened through, for example the application of a deliberately fatal drug overdose. The resulting four possibilities can now be examined within the moral frameworks outlined at the beginning of this essay.

Let me begin by examining the deontological arguments against euthanasia. That is, that euthanasia is intrinsically morally wrong irrespective of the consequences. What is the basis for this position? Behind such arguments tend to be the belief in the sanctity of human life (which may or may not be grounded in a religious belief that life is a gift from God). This view was supported by Immanual Kant who believed that the rational human being has an inherent value. Indeed, he argues explicitly that a man tired of life cannot morally end that life because, to do so would “be utterly in conflict with the supreme principle of duty” (Kant, 1785). Taken to its conclusion, this reasoning could ordain that it is an individual’s moral duty to stay alive, whatever the personal cost to himself and his family, until such time as he “naturally” dies. Views such as this have led to what in what, in my opinion, is an abhorrent defence and glorification of the ‘value of suffering’ by the Catholic church in Pope John Paul’s Salvifici Dolores. This Apostolic letter published in February 1984 points to God’s deliberate tormenting of a just man (Job) in order to test his righteousness and the suffering of Christ of the Cross amongst other “evidence” that divine redemption is rooted in suffering and it argues that those who suffer should rejoice that they are being brought closer to God. The idea that suffering can be a ‘good’ thing for an individual implicitly sanctions poor palliative care and has, some would argue, led directly to the unnecessary suffering of many people. (Hitchens,1995).

The acceptability or otherwise of euthanasia within a deontological framework can depend very much on the definitions contained within the premises of the argument. The argument that it is intrinsically wrong to ‘kill’ another (innocent) human being is an example. Whilst this may be accepted by most people as ‘self-evident’, it is currently accepted practice in the UK that withdrawing treatment from patients (passive euthanasia) is not the same as actively hastening the individual’s death (active euthanasia). Despite the fact that the outcomes are the same (the individual dies as the result of the action), one is seen as ‘killing’ but the other isn’t. One justification put forward to justify passive euthanasia is that the patient’s “right” not to be assaulted [by invasive medical treatment] in some way “trumps” the duty to continue living (Velleman,1992) however this does not change the fact that the individual dies as a result of a decision being made. As Beuchamp argues, the physician cannot ‘side-step’ responsibility for a patient in his care. The decision to withdraw or not to withdraw treatment is a conscious act with consequences known and understood by the individual making the decision therefore they cannot abnegate responsibility for the outcome (Beuchamp, 1996). If passive euthanasia cannot be justified on deontological grounds as morally different from active euthanasia - because of difficulties distinguishing ‘killing’ and ‘letting die’ - and the outcomes of the decision to passively euthanise could be to prolong suffering as a patient dies slowly from dehydration, surely this ‘half-way house’ is both morally repugnant and wholly unjustifiable.

Having explained my objections to deontological arguments against euthanasia, I will now turn to the consequentialist view. There are a number of consequentialist arguments against euthanasia under any circumstances. The main objection being what is called ‘the slippery slope’ argument – that is that voluntary euthanasia would be a ‘slippery-slope’ ending in the social acceptance of involuntary euthanasia. Other concerns relate to the difficulty of ensuring ‘proper’ regulation if euthanasia were to be permitted in certain circumstances in addition, arguments have been made which propose that simply by granting the individual the option to die, this could quickly become an obligation to die. I will deal with each of these three arguments in turn.

The ‘slippery slope’ argument proposes that by allowing something which appears relatively harmless today, the action will result in a re-calibration of society’s accepted norms and slowly, through incremental change, that which was once deemed unacceptable becomes acceptable. I reject this argument for two main reasons. As Beuchamp points out, this reasoning means that “patients should be denied help not because of anything that they have done or because of any demerit in their case or in their wishes but because acts of assistance in dying would hurt others” (Beuchamp,1996). I would actually replace the word ‘would’ in the previous sentence with ‘may’ as I do not feel that there is a truly logical reason why one thing should necessarily lead to the other. In fact, I would argue that, in the main, society understands that involuntary euthanasia – the active killing of innocent people against their wishes - can never be justified in a civilised society. I believe that in most communities, we understand and accept implicitly or explicitly our fundamental right not to be killed against our wishes. Without this understanding, life would indeed be ‘nasty, brutish and short’ (Hobbes, 1651). Such is the strength of this belief within a civilised society that I do not accept that the introduction of euthanasia under carefully defined circumstances would be allowed to metamorphosise into something so unacceptable. Slippery slope arguments are, in my opinion, the last bastion of the vested interest, seeking to justify the status quo through scaremongering and propaganda and they can’t be supported on moral grounds. In a ‘free’ society we should rely on rational debate to judge individual decisions on their own merit and have some assurance that by starting on one path it does not necessarily follow that the only way is down.

So, assuming that we are not going to be opening the floodgates to unlawful killing as a result of restricted acceptance – when can euthanasia be potentially justifiable? Those who subscribe to autonomy as the basic right of a rational human being where “the individual is sovereign… over his own body and mind” (Mill, 1869) might argue that the answer is ‘whenever the individual wants to die’ as long as no-one else is harmed. I find this argument difficult to oppose in principal however it is useful only as a justification for voluntary euthanasia carried out by a rational individual and where the death of that individual will have cause no direct harm to another. It offers us no guidance on the trickier question of non-voluntary euthanasia when, by definition, the individual has lost autonomy over his own body and is at the mercy of another when the decision is made. The introduction of a proxy makes things more complicated. Who can really judge whether someone should be killed for ‘their own good’ other than the person inhabiting that body? How can we be sure that the killing really is always in the individual’s best interest rather than in the interest of the proxy responsible for making the decision? Such questions have, in my opinion been the main stumbling block for attempts to introduce any kind of non-voluntary euthanasia. The answer is most probably that we can never be 100% certain, but we can reduce the risk of error as much as possible by introducing safeguards such as delaying the decision until the final stages of an illness, requiring independent medical advice and disallowing any heirs to be involved in the decision-making process (Hooker, 2007). A utilitarian would try to establish whether a properly thought out and enforced system of checks was of enough benefit to the whole of a suffering population to outweigh a small number of errors in either diagnosis or motive. With 75% of the UK population now supporting some kind of assisted dying in principal (YouGov,2010) it appears that the public might be ready to accept this level of risk.

The last consequentialist argument against euthanasia that I will examine is the proposition that, simply by offering euthanasia as an option, the individual will feel pressured to die. Velleman argues that, by having a choice in the matter and lifting the taboo on euthanasia, individuals could be required, at a time when they are at their lowest ebb, to face up to a hitherto unexamined obligation to justify their continued existence. Offering the option of dying may “give people new reasons for dying” (Velleman, 1992). I do not find this argument persuasive enough to merit over-ruling the right to choose. I think that Velleman underestimates both the survival instinct of the individual and the natural bonds between family members which can go a long way towards justifying one’s continued existence despite the most onerous challenges. This is evidenced by Hardwig who relates that “families deliver more than 80% of long-term care in the US, almost always at great personal cost” (Hardwig, 1996). Under the current set of affairs where euthanasia is still the great taboo, there can be grave consequences to the family and friends of the individual both emotional and financial. Hardwig’s utilitarian argument is that the individual has a duty to die when the lives of his loved ones are greatly impoverished as a direct result of his continued existence. Unlike other commentators, Hardwig argues that ‘being a burden’ is actually a legitimate reason for requesting death and that we should spend less time and effort avoiding death at all costs and prepare instead for a ‘good’ death. Continuing to dodge the issues resulting from continued advances in modern medicine will result in the reduction of the overall well-being as families and society try to cope with an increasingly aging population and would therefore be morally wrong. Whilst I may recoil from the idea that someone can have a ‘duty’ to die which implies that it is not something done voluntarily, I find it difficult to argue with Hardwig’s idea that we should all face up to and prepare for what will, inevitably come to us all. It is time that these issues were spoken about freely and without fear of being prosecuted or ostracised by society.

In conclusion, I have proposed that where there is no harm to another, a rational individual should be able to decide what to do with his own body. I would therefore argue that voluntary euthanasia should always be allowed when the individual is found to be of sound mind and no (or incidental) harm would come to any individual as a direct result. I have argued that there is little moral difference between so-called ‘passive’ and ‘active’ euthanasia and therefore I would propose that in a society that accepts non-voluntary passive euthanasia there appears to be little reason not to accept non-voluntary active euthanasia where there are sufficient safeguards to ensure that the proxy’s needs are not taking undue precedence over the individual’s. In these circumstances I believe that euthanasia can be justified.

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May 31st, 2011, 1:28 pm
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Many of us on this forum believe that there are no moral absolutes - that morality is within each of us, so that no one's sense of right and wrong is exactly like another's, and that there's no logic to prove that a saint's moral sense is any more "absolutely right' than a sociopath's. So what do we mean when we say that something is "right" or "wrong"? We mean that according to our own moral standards, which in most cases are similar to those of the community, an act is acceptable, or not.

There are two ways that people develop their moral system. One relies on rules - religious precepts or laws of the state or rules laid down by tradition. The other is based on empathy and compassion. The first has the advantage of more clearcut distinctions. The second requires judging each situation on its own merits, more or less by the amount of happiness it's likely to cause vs the amount of pain it's likely to cause.

In general those who oppose all euthanasia are doing so on the basis of a moral rule being violated. "Thou shalt not kill." In general those who favor making euthanasia legal are doing so on the basis of sympathy for the sufferer.

Personally I'm in favor of assisted suicide, but only with safeguards. I can imagine situations where the person would feel pressure from family to end it all. And we must remember that depression, which would lead many to consider euthanasia, is often cyclical. At a low point, someone might want to die, but a week later, would be glad he didn't. So before assisted suicide is approved, a panel must be convinced that the medical issue is severe enough to warrant it, and that the patient has been steadfast in his desire to die for a prolonged period of time.


May 31st, 2011, 9:06 pm
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Wilson wrote:
Personally I'm in favor of assisted suicide, but only with safeguards. I can imagine situations where the person would feel pressure from family to end it all.
I find it hard (though not impossible) to believe that family members would exert pressure on a loved one to top themselves, indeed I think the opposite would be more likely, folk being selfish and all.

Quote:
And we must remember that depression, which would lead many to consider euthanasia, is often cyclical. At a low point, someone might want to die, but a week later, would be glad he didn't.
Depression is an illness treatable with medication and where a full recovery can be achieved, I don't think any GP worth his/her salt would assist in the suicide of a depressive.
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So before assisted suicide is approved, a panel must be convinced that the medical issue is severe enough to warrant it,
So does this panel get to feel the pain? Or suffer the indignity? Before reaching their decision?

Quote:
and that the patient has been steadfast in his desire to die for a prolonged period of time.
The whole idea of assisted suicide is that a person does not have to want to die "for a prolonged period of time" otherwise they might just as well wait for the natural end.

I have had many of my dogs euthanized over the past 50 years, it's hard but not as hard as seeing them suffer, what's the difference with humans?

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May 31st, 2011, 9:36 pm
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Are you saying that no family member with the prospect of a huge inheritance would ever put subtle pressure on an elderly parent? Don't you read mystery novels?

Depression isn't always treatable successfully. Certainly it isn't curable by medication in most, though it may clear up on its own. And the severity comes and goes, as a natural part of the disease. Are you saying that if a person with chronic pain has a really bad week, he or she should be allowed to enlist a doctor to end his or her life? Granted, most doctors wouldn't go along with it, if there is the prospect of improvement, but there are a few doctors out there without a lick of sense who might use bad judgment. It would be crazy not to require safeguards.


June 1st, 2011, 12:16 am
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Quote:
Wilson
Are you saying that no family member with the prospect of a huge inheritance would ever put subtle pressure on an elderly parent?
No I didn't say that, I said "I find it hard (though not impossible) to believe that family members would exert pressure on a loved one to top themselves,"

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Don't you read mystery novels?
No.

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June 1st, 2011, 12:12 pm
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Beki wrote:
A bit of a read, but thought I would share...


Thank you Beki, your essay is a very interesting read. I particularly liked
Quote:
It is time that these issues were spoken about freely and without fear of being prosecuted or ostracised by society.

The fact that slow - rather than brutal accidental - dying is done behind closed doors in that it's not a polite topic of conversation, inhibits the discussions we should all be having with our loved ones. When you are dying it's too late. How can your loved ones ask if you want a DNR (do not resuscitate) when you know you are dying? Not only do we need to talk now freely and without fear about these issues to our families, we need to work out at what level life would be intolerable for us, as individuals. And clearly communicate that to our family, GP and solicitor.

My main work includes caring for terminally ill folk and their families. I can assure you that those families who have had those discussions suffer less than those who haven't, especially where pain control is concerned.

This issue, IMHO must be wholeheartedly discussed without fear. As Alan C said: we allow our pets that dignity...


June 1st, 2011, 9:22 pm
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