Advocates of euthanasia and their opponents frequently explore the distinction between active and passive euthanasia. Active euthanasia is an act of killing; in contrast, passive euthanasia is the withdrawal of life sustaining treatment, or allowing a person to die. Supporters of euthanasia, generally argue that there is no morally relevant distinction between ‘active’ and ‘passive’ euthanasia, as death is the ultimate goal of both. The manner of death is what they oppose. I intend to explore the moral significance of this distinction and demonstrate that ‘passive’ euthanasia is primarily in correspondence with a patient’s right to refuse treatment, endorsing the moral permissibility of passive euthanasia only in certain circumstances. Death being a consequence of exercising this right is merely convenient to the terminally ill. I will endeavor to illustrate that there seems to be an increasing amount of social approval for our right to refuse life-sustaining treatment specifically to hasten death in certain circumstances. I believe this then opens the door to the moral permissibility of active euthanasia in similar circumstances also.
The Oxford dictionary definition of euthanasia states its meaning as ‘a gentle and easy death’. Euthanasia is derived from the Greek language; eu means ‘good’ and thanatos means ‘death’. In order to get to the fundamental meaning of the word, it is necessary to stipulate that any candidate for euthanasia must have a painful and terminal illness. The death must be assisted and must be for the sake only of the person considered.
James Rachels questions the moral distinction between active and passive euthanasia. He asserts in the case of a terminally ill patient, who dies as a consequence of refusing life-sustaining treatment, killing the patient would not be morally worse. He states, “If a doctor lets a patient die, for humane reasons, he is in the same moral position as if he had given the patient a lethal injection for humane reasons”. Rachels believes it absurd that it is not morally permissible to administer a lethal injection to relieve the pain and suffering that a patient invariably experiences after the decision has been made to discontinue life- sustaining medical care.
One crucial aspect which Rachels fails to consider, is that it is the patients ‘right’ to refuse treatment. This should not be confused with a doctor’s decision to discontinue treatment, as the decision is made solely by the patient for his own ends. For example, I can refuse to have invasive surgery opting instead to be treated by medication (where applicable). It is not my intention to hasten death; I am merely exercising my right to refuse treatment.
This becomes problematic when the intention behind the refusal of treatment is specifically to hasten death. Consider a terminally ill patient suffering intense pain with no reasonable hope of relief or the disease being cured. He refuses treatment that cannot help him but can only prolong his agonizing existence. It may be argued that consistency demand that, by complying with a patient’s request to cease life-sustaining treatment, patients in similar circumstances have a right to decide to end life and obtain assistance in doing so.
I agree with Bonnie Steinbock’s assertion that “The right to refuse treatment is not itself a ‘right to die’; that one may choose to exercise this right even at the risk of death or even in order to die, is irrelevant.” To extend our interpretation of our right to bodily self-determination to include a right to die would be a huge extension to our right to non-interference from others. Rachels appeal for consistency demands that as we do have a right to refuse treatment, we then have to agree that we also have a right to be killed.
The practical consequences of such a move in this argument would be most inappropriate, as it would leave room for gross manipulation of the ultimate intention of those who support euthanasia. For instance, if my right to refuse treatment included a right to be killed, I could abstain from treatment for an initially non-life threatening condition such as appendicitis. It may then become life threatening, and I could then demand (as consistency allows) that I be killed by lethal injection. This may be because I am depressed, I may feel life is no longer worth living, but not have the capacity or the inclination to commit suicide. This I imagine would be totally unacceptable even to the most enthusiastic supporters of euthanasia. It is a consequence that is morally impermissible, and thus I doubt would be the intention of those wishing to ease the pain and suffering of those who are genuine candidates for euthanasia.
My right to refuse life-sustaining medical care does not include a right to intentionally end my life. I have a right only to bodily self-determination, which is primarily a right to be left alone. Steinbock believes that the fact that death may occur, because of refusing treatment, is irrelevant. I propose that it should be recognized as a fortunate convenience to the terminally ill. For example, If as a consequence of my withdrawal from medical care I hasten my otherwise long and painful death (even if my intention is to hasten my death), surely this should be seen as a convenient blessing, which holds no moral implications or obligations for any person other than myself. It is a fortunate consequence to be able to use my right to bodily self-determination, for my own ends, or more specifically for hastening my death. Far from being irrelevant, it is therefore a very relevant factor to be considered.
I feel that there seems to be an increasing amount of social approval and sympathy for those intending to shorten their lives by ceasing treatment in certain circumstances. For example, take the person who has suffered years of intense and unbearable pain as a consequence of a long and drawn out incurable illness, which is treatable only by measures that increase discomfort of the sufferer. The treatment has no other benefit but to prolong existence. The person is completely non-functional with the exception of being conscious and aware. Conscious and aware only of a life of intolerable pain, this could take weeks, months or even years to expire with the continuation of treatment. In this instance and similar situations where death would come as a great relief to these people, I believe that the right to discontinue treatment, specifically to hasten death, would be granted the moral approval of most people.
However, when treatment is discontinued, it may nevertheless take days, weeks or months of insufferable pain for death to occur naturally. In this instance and similar circumstances, once the initial decision to die has been made by the patient, would it not be more humane to assist the patient by administering a lethal injection that would achieve death instantly and painlessly?
Some may find my proposal of this inconsistent with my assertion that we do not have any right to die, and we certainly have no right to be killed. However, I merely seek to illustrate that there seems to be some kind of moral approval for allowing a person to die in some instances. I question as to whether this could leave the door open to the moral permissibility of providing an option of assisted death to a patient in similar circumstances. It is not my intent to advocate that in all cases where a patient may refuse life-sustaining treatment, it is desirable to provide an option of assisted death. As I demonstrated earlier, this may be easily perverted and as a result have very unfortunate practical consequences.
I aim only to show that in some extreme instances it may be more humane to actively end a life. We do not think twice when we relieve a disabled horse of a painful existence, yet we become excessively cautious (with good reason) when we contemplate the moral permissibility of assisting the death of a person. I assert that where a person is in insufferable pain, which cannot be relieved or cured, the option of a ‘gentle and easy’ death may be provided, and may be morally permissible.
In conclusion, advocates of active euthanasia who appeal to the basic consistency argument, demand that if we can allow people to die, we can then transfer to the moral permissibility of killing them. However, the right to refuse treatment is not a right to die. We do have a right to non-interference even if exercising this right may hasten death. Death being a consequence of our right to bodily self-determination should be viewed as fortunate side effect to those who are suffering from painful and incurable illnesses. There seems to be some kind of social approval for using our right to non-interference for our own ends, particularly to hasten death in extreme cases of suffering. This I believe leaves open the possibility of the moral permissibility of providing the option of assistance in similar cases. I argue for the permissibility of active euthanasia in extreme cases. However, I do recognize that strict guidelines would need to be followed to prevent the process being perverted and to ensure that genuine candidates for euthanasia are given the option of a dignified, pain free death.