Arguments in favour of euthanasia

Regulation of euthanasia

It's not possible to regulate euthanasia

Euthanasia opponents don't believe that it is possible to draft laws and guidelines that will prevent the abuse of euthanasia.

It's possible but very difficult

Those in favour of euthanasia think that there is no reason why euthanasia can't be controlled by proper regulation, but even they fear that regulations won't deal with people who want to implement euthanasia for bad motives.

This is little different from the position with any crime. The law prohibits murder, but that doesn't stop bad people committing murders.

Nonetheless, people worry that whatever regulations are put into place they won't stop, particularly vulnerable, patients being pressured to choose death when they would rather live for a few more weeks.

Some rules are better than none

It's hard to think that creating a structure to regulate euthanasia will have a worse result than not having any regulations at all.

Since euthanasia will continue to take place, even though it's illegal, it would surely be better to make it legal and regulate it so as to minimize abuse.

A similar argument was used as part of the case for making abortion legal. It's not that convincing if it's the only argument.

However, vulnerable patients might be better protected if there were set procedures and rules that had to be followed for euthanasia than they are at present.

Indeed a patient who feared that they were under pressure to decide in favour of euthanasia would be able to gain help and support by initiating the formal procedures involved in regulated euthanasia - something that they cannot do now.

Elements of regulation

For safeguards to be meaningful and effective, they have to involve investigations of the patient's psyche, his family dynamics and the financial implications of his death, among with more obvious things such as the patient's medical condition, and the likely course of the disease.

In order to ensure that requests are properly considered, both by the patient, the family, and the authorities, regulations need to build in a time-period for reconsideration.

Proper regulation must also make sure that a patient was receiving good palliative care before a request for euthanasia is considered.

Although the procedures outlined above are time-consuming and expensive, that does not mean that they are impractical.

The Oregon approach

The US state of Oregon legalised physician assisted suicide in 1998. During the first three years only around 2 people a month used this to end their lives. This was partly because of the severe conditions that had to be satisfied before a request for euthanasia could be granted:

• patient must be resident in Oregon
• patient must be aged over 18
• patient must make 2 oral and 1 written request for euthanasia
• there must be at least 15 days between the first and the last request
• patient must be terminally ill with a life expectancy of less than 6 months
• this prognosis must be confirmed by a second consultant physician
• both doctors must confirm that the patient is capable of making this decision
• both doctors must confirm that the patient does not have medical condition that impairs their judgement
• patient must self-administer the lethal medication

About 30% of patients who started the process died before it was completed. 19 patients in the period who were given access to lethal medication decided not to use it. One survey showed that 45% of patients who were given good palliative care changed their mind about euthanasia.

Another reason for the low take-up was the difficulty of finding a doctor who go along with the request: The Oregon Health Division reported that only a fifth of physicians of control patients dying of similar terminal illnesses would have prescribed a lethal medication if asked.

The Dutch approach

In the Netherlands voluntary euthanasia and assisted suicide are still criminal offences, but doctors are exempt from criminal liability in certain circumstances. The Netherlands Criminal Code Article 293, paragraph two, stipulates that the doctor:

• must be convinced that the patient has made a voluntary and well-considered request to die
• must be convinced that the patient is facing interminable and unendurable suffering
• has informed the patient about his situation and his prospects
• together with the patient, must be convinced that there is no other reasonable solution
• has consulted at least one other independent doctor who has seen the patient
• and given his written assessment of the due care requirements as referred to in the points above
• has helped the patient to die with due medical care

The Dutch law also permits euthanasia for non-adults. Children of 16 and 17 can make their own decision, but their parents must be involved in the decision-making process regarding the ending of their life. For children aged 12 to 16, the approval of parents or guardian is required.

If a patient can no longer express their wishes, but made a written statement containing a request for termination of life before they became incompetent, a doctor is allowed to carry out their request providing the other conditions are met.

Two thirds of the requests for euthanasia that are put to doctors are refused. Neither doctors nor nurses can ever be censured for failing to comply with requests for euthanasia.

The right to die

Human beings have the right to die when and how they want to

Many people think that each person has the right to control his or her body and life and so should be able to determine at what time, in what way and by whose hand he or she will die.

Behind this lies the idea that human beings should be as free as possible - and that unnecessary restraints on human rights are a bad thing.

And behind that lies the idea that human beings are independent biological entities, with the right to take and carry out decisions about themselves, providing the greater good of society doesn't prohibit this. Allied to this is a firm belief that death is the end.

Religious objections

Religious opponents disagree because they believe that the right to decide when a person dies belongs to God.

Secular objections

Secular opponents argue that whatever rights we have are limited by our obligations. The decision to die by euthanasia will affect other people - our family and friends, and healthcare professionals - and we must balance the consequences for them (guilt, grief, anger) against our rights.

We should also take account of our obligations to society, and balance our individual right to die against any bad consequences that it might have for the community in general.

These bad consequences might be practical - such as making involuntary euthanasia easier and so putting vulnerable people at risk.

There is also a political and philosophical objection that says that our individual right to autonomy against the state must be balanced against the need to make the sanctity of life an important, intrinsic, abstract value of the state.

Secular philosophers put forward a number of technical arguments mostly based on the duty to preserve life because it has value in itself, or the importance of regarding all human beings as ends rather than means.

The right to life includes the right to die

• The right to life is not a right simply to exist
• The right to life is a right to life with a minimum quality and value
• Death is the opposite of life, but the process of dying is part of life
• Dying is one of the most important events in human life
• Dying can be good or bad
• People have the right to try and make the events in their lives as good as possible
• So they have the right to try to make their dying as good as possible
• If the dying process is unpleasant, people should have the right to shorten it, and thus reduce the unpleasantness
  • People also have obligations - to their friends and family, to their doctors and nurses, to society in general
  • These obligations limit their rights
  • These obligations do not outweigh a person's right to refuse medical treatment that they do not want
  • But they do prevent a patient having any right to be killed
• But even if there is a right to die, that doesn't mean that doctors have a duty to kill, so no doctor can be forced to help the patient who wants euthanasia.

The right to life gives a person the right not to be killed if they don't want to be.

• Respect for this right is sufficient to protect against misuse of euthanasia, as any doctor who kills a patient who doesn't want to die has violated that person's rights.
• Allowing euthanasia will greatly increase the risk of people who want to live being killed. The danger of violating the right to life is so great that we should ban euthanasia even if it means violating the right to die.

The rights to privacy and freedom of belief give a person the right to decide how and when to die.

The European Convention on Human Rights gives a person the right to die.

• Not according to Britain's highest court.
• It concluded that the right to life did not give any right to self-determination over life and death, since the provisions of the convention were aimed at protecting and preserving life.

English law already acknowledges that people have the right to die.

• The Suicide Act (1961) made it legal for people to take their own lives.
  • This doesn't necessarily acknowledge a right to die.
  • it could simply acknowledge that you can't punish someone for succeeding at suicide
  • and that it's inappropriate to punish someone so distressed that they want to take their own life.
• Although the Suicide Act makes it a crime to help someone commit suicide, this provision is really there to make it impossible to escape a murder charge by dressing the crime up as an assisted suicide.

Libertarian argument

The libertarian argument

This is a variation of the individual rights argument.

• If an action promotes the best interests of everyone concerned and violates no one's rights then that action is morally acceptable
• In some cases, euthanasia promotes the best interests of everyone involved and violates no one's rights
• It is therefore morally acceptable

Objections to this argument

Opponents attack the libertarian argument specifically by showing that there are no cases that fit the conditions above:

• people sometimes think things are in their best interests that are not morally acceptable
  • The arguments that euthanasia is intrinsically wrong fit in here
• people are sometimes wrong about what's in their best interests
• people may not realise that committing euthanasia may harm other people more about this
• euthanasia may deprive both the person who dies and others of benefits
• euthanasia is not a private act - we cannot ignore any bad effects it may have on society in general

Medical resources

Euthanasia may be necessary for the fair distribution of health resources

This argument has not been put forward publicly or seriously by any government or health authority. It is included here for completeness.

In most countries there is a shortage of health resources.

As a result, some people who are ill and could be cured are not able to get speedy access to the facilities they need for treatment.

At the same time health resources are being used on people who cannot be cured, and who, for their own reasons, would prefer not to continue living.

Allowing such people to commit euthanasia would not only let them have what they want, it would free valuable resources to treat people who want to live.

Abuse of this would be prevented by only allowing the person who wanted to die to intitiate the process, and by regulations that rigorously prevented abuse.

Objections to this argument

This proposal is an entirely pragmatic one; it says that we should allow euthanasia because it will allow more people to be happy. Such arguments will not convince anyone who believes that euthanasia is wrong in principle.

Others will object because they believe that such a proposal is wide-open to abuse, and would ultimately lead to involuntary euthanasia because of shortage of health resources.

In the end, they fear, people will be expected to commit euthanasia as soon as they become an unreasonable burden on society.

Universalised moral rule

Moral rules must be universalisable

One of the commonly accepted principles in ethics is that only those ethical principles that could be accepted as a universal rule (i.e. one that applied to everybody) should be accepted.

So you should only do something if you're willing for anybody to do exactly the same thing in exactly similar circumstances, regardless of who they are.

The justification for this rule is hard to find - many people think it's just an obvious truth (philosophers call such truths self-evident). You find variations of this idea in many faiths; for example "do unto others as you would have them do unto you".

To put it more formally:

The person in favour of euthanasia argues that giving everybody the right to have a good death through euthanasia is acceptable as a universal principle, and that euthanasia is therefore morally acceptable.

Necessary but not sufficient...

This is true, but only up to a point...

If a person wants to be allowed to commit euthanasia, it would clearly be inconsistent for them to say that they didn't think it should be allowed for other people.

But the principle of universalisability doesn't actually provide any positive justification for anything - genuine moral rules must be universalisable, but universalisability is not enough to say that a rule is a satisfactory moral rule.

Universalisability is therefore only a necessary condition, not a sufficient condition for a rule to be a morally good rule.

So universalisibility doesn't advance the case for euthanasia at all.

And anyway...

Every case is different in some respect, so anyone who is inclined to argue about it can argue about whether the particular differences are sufficent to make this case an exception to the rule.

And finally...

Oddly enough, the law of universalisability allows for there to be exceptions - as long as the exceptions are themselves universalisable. So you could have a universal rule allowing voluntary euthanasia and universalise an exception for people who were less than 18 years old.

Euthanasia happens anyway

Euthanasia happens - better to make it legal and regulate it properly

Sounds a bit like "murder happens - better to make it legal and regulate it properly".

When you put it like that, the argument sounds very feeble indeed.

But it is one that is used a lot in discussion, and particularly in politics or round the table in the pub or the canteen.

People say things like "we can't control drugs so we'd better legalise them", or "if we don't make abortion legal so that people can have it done in hospital, people will die from backstreet abortions".

What lies behind it is Utilitarianism; the belief that moral rules should be designed to produce the greatest happiness of the greatest number of people.

If you accept this as the basis for your ethical code (and it's the basis of many people's ethics), then the arguments above are perfectly sensible.

If you don't accept this principle, but believe that certain things are wrong regardless of what effect they have on total human happiness then you will probably regard this argument as cynical and wrong.

But even if...

...you do agree with the argument above, you then have to deal with the arguments that suggest that euthanasia can't be properly regulated.

Is death a bad thing?

Why does it matter?

If death is not a bad thing then many of the objections to euthanasia vanish. Once we get past the idea that death is a bad thing, we are able to consider whether death may actually sometimes be a good thing.

This makes it much easier to consider the issue of euthanasia from the viewpoint of someone who wants euthanasia.

Why is death a bad thing?

Death is regarded as a bad thing:

• because human life is intrinsically valuable
• because life and death are God's business with which we shouldn't interfere
• because most people don't want to die
• because it violates our autonomy in a drastic way

The last two reasons why death is a bad thing are not absolute; if a person wants to die, then neither of those reasons can be used to say that they would be wrong to undergo euthanasia.

People don't usually want to die

People are eager to avoid death because they value being alive, because they have many things they wish to do, and experiences they wish to have.

Being dead, versus not having been born

But some people say that being dead is not different from not having been born yet, and nobody makes a fuss about the bad time they had before they were born.

There is a big difference - even though being dead will be no different as an experience from the experience of not having yet been born.

Death hurts people because it stops them having more of the things that they want, and could have if they continued to live.

Violation of autonomy

Another reason why death is a bad thing is that it's the worst possible violation of the the wishes of the person who does not want to die (or, to use philosopher-speak, of their autonomy).