Euthanasia

                                 The Ethics of Ending a Human Life


                                               Essay














                                      Bc. Gabriela Miklišová



Healthcare Ethics

2022

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Synopsis

1.     Controversy of the extremes. 3

2.     For or against - human morality. 3

3.     The UK situation.. 4

4.     Czechia vs. the rest of the western world.. 5

5.     Death tourism... 6

6.     Natural human fears. 7

7.     In closing.. 7

Citation resources. 8



1.    Controversy of the extremes

To pick a more controversial topic, you would have to go looking quite far. Most of it comes from
the basic human need for self preservation. The so-called survival instinct. Unlike other animals,
humans are self aware. This condition gives us not only the amazing opportunities to experience our
lives understanding oneself but also poses the threat of death. The ultimate ending to our
existence.

We are all slaves our brains and within that structure lies the this huge bogeyman. The biggest
part of this fear is based in our history of organised religion. Most religious practices have the
need to invent a culture of an afterlife. One reason is to create a fright of divine punishment, a
sort of a control system over the population to keep it within constraints of certain desirable
behaviours. The other reason is to ease the process of dying. Whether we consciously admit it or
not, the ultimate end waits for us all. Yet we are as a whole more dissociated from it than ever.
[1]

In terms of practicality, what is the ultimate freedom? Is it to be able to decide when our time is
up? Or is that just some sort of self delusional thinking? Let’s take a peek into the abyss that is
the assisted ending of a human life. Why should we have the right to choose the time and place of
our own end? Why shouldn’t we? [1,3]

2.    For or against - human morality


Let’s look at the pros and cons of euthanasia in general. The most prevalent argument for the use
of euthanasia is the patients autonomy and there right to make decisions about their person.
Objectively that could mean their decision to end their suffering, be it physical or mental.
Usually there are two main conditions that have to be fulfilled in order to legally perform
assisted suicide. The patient has to be terminally ill and they have to be able to make the final
decision themselves. There are of course exceptions to this rule, for example in the Netherlands,
where doctors can make this decision unilaterally. As an extra note, most experts in favour of
euthanasia believe that ending one’s life with dignity is also one of the reasons. [1,3]

The topic of passive versus active euthanasia comes to mind as well. On its legal merits,
unplugging a person from life supporting machinery after twelve years of being in a coma might be
the same as delivering the life ending drug to their veins. Morally and mainly in the eyes of the
doctors administering this final treatment, the difference is huge. [2]

The most valid arguments against assisted suicide are as follows. The legalisation of euthanasia
will innevitably decrease the quality of care for the terminally ill patients. It will also make
developing new cures for the terminally ill less desirable from the standpoint of pharmaceutical
companies. As for the simple human nature reasons, the cases where relatives of some patients were
known to benefit from their early death, haven’t been a few. [1,2]

The regulation, the government's primary job, turns out to be one it is not particularly good at.
In a situation where the stakes are literally life or death, it doesn’t seem like a great idea to
hand that power over.

As a last, but certainly not least, where good palliative care is available, the use of euthanasia
becomes almost obsolete. [1,2]

3.    The UK situation

For example in the UK the question of assisted end of life procedures has been widely discussed for
a long time. The way they approach it is three pronged.

First is the We need it way of thought, meaning the so-called compassion argument. This thinking
focuses on the patient’s need to end their life with dignity rather than arbitrarily prolonging
their suffering for the sake of a longer life.

The second is the We want it argument, which focuses on the individual's right to choose when to
end their life when they choose to. This comes down to the so-called true freedom, which means as
an individual, you have the solemn right to make decisions about your mind and body. [3,4]

The third one is the We can control it approach. It basically states that a government can safely
make rules for an assisted suicide.

These are the arguments for euthanasia. The truth is there is no right answer to this question and
we would have to consider many variables in each individual case. [3,4]


Now let’s delve into the reasoning behind the against argument within the UK structure. There are
four main ways the British think about it.

There are alternative treatments available - clearly contradicts the first and second argument for
euthanasia. A simple example will suffice to demonstrate the flaws in this way of thinking. Let’s
say there is a stage four cancer patient. Even with new treatments being developed every day, the
chance of saving this person is statistically insignificant. We might be able to prolong their life
by a couple weeks, maybe even months, but the quality of that life would be deteriorating
incredibly on a daily basis. So the real question is do we want to put an enormous dose of pain and
suffering on this person just to satisfy some arbitrary form of ethical tradition, or can we help
them escape the pain and let them end their life with dignity? [3,4]

The second argument against is that there is no ‘right’ to be killed and the slippery slope of
assisted suicide is real. The main fear here is that voluntary euthanasia would later become
involuntary and that the doctors would in some cases have the power to make end of life decisions.
This fear is not without its merits. For example in the Netherlands in the year 1990, around one
thousand of patients were killed without their request. [1,2,4]

 The third argument goes right against the ‘We could control it’ point, saying ‘We could not
control it’. There is widespread evidence from around the world that doctors don’t always report
these occurrences. Take the for profit healthcare systems, like the one in the US into account and
you have a recipe for the perfect disaster. [1,2]

The fourth and final argument says the assumption that a patient should have a right to die would
impose on doctors a duty to kill. The fear is that a right to die could in some cases mean
something of a duty to die, which would take away the doctors autonomy. [1,2]


4.    Czechia vs. the rest of the western world

If we compare our state of affairs with other western countries, it is quite abysmal. As far as
legislation goes, assisted suicide is pretty much equal to murder in the eyes of the law. There is
nothing even close to a discussion on the political level. Even within the medical community it is
still very much a taboo topic. Medical staff who try to put this discussion forward are often seen
as pariahs. If we could just move away from the demonisation of the topic, that would probably be a
great first step. We live in the twenty first century after all. The feudal system has been long
gone, and even the dictatorships of the twentieth century are over. Yet this inability to confront
difficult topics seems to be ingrained in our DNA. As one of the most atheistic countries in
Europe, we should be leading the discussion on topics like euthanasia.

If we assume that a person has the right to choose his or her own way of life, then it can be
concluded that there should be a fundamental right to choose the moment of death of an individual,
provided specific, predefined conditions occur. The right to decide freely and voluntarily when one
no longer wishes to live. Proponents of euthanasia argue that just as the right to life is sacred,
so should the right to die. However, the legal view of this right must be properly balanced. Death
must be a dignified choice of the suffering person, and the passing of each person should be
treated with due respect.  [1,2,3]

In 2019, a regular public opinion poll was conducted in the Czech Republic on controversial issues,
including euthanasia. It was conducted by the Centre for Public Opinion Research, Institute of
Sociology of the CAS. The research instrument was a standardized questionnaire. It was presented to
the population of the Czech Republic aged 15 years and older and the number of respondents was
1026. The survey asked whether the respondents agreed or disagreed whether the legal system of the
Czech Republic should allow the ending of the life of a terminally ill person, or euthanasia.
Approximately two thirds (66%) of the respondents expressed that they strongly or rather agree,
i.e. that euthanasia should be included in our legal system. Approximately one-quarter of
respondents (23%) disagreed with the enactment of euthanasia and approximately one-tenth (11%) were
unable to comment on the issue. [1,2,3]

5.      Death tourism

This part is probably the most controversial of all. Some countries, most prominently Switzerland,
allow not only their citizens, but also citizens from other countries to apply for assisted
suicide. For example the infamous Dignitas clinic utilises this opportunity to the limits. They use
it as an excellent business model. For anyone to be admitted and allowed to undergo euthanasia,
they first have to be members of the clinic and pay hefty fees over a period of time. The patient
admitted still has to fulfil the necessary criteria, meaning terminal illness and ultimately the
decision lies with the attending physician. Like in all other things in life, if you have enough
money, you can ensure your way out of a miserable existence. [4]

6.     Natural human fears

As I have mentioned earlier, the basic fear of death comes from the unknown. Most people, unless
suffering from incredible pain, physical or mental, will choose not to end their life simply from
this fear. For many the reasons might be religious. After all, all religious doctrines are obsessed
with death and what comes after.

Unfortunately, the people who would probably choose to end their suffering promptly are often
labelled unstable, or in no condition to decide their fate. How could we understand someone's
decision which is so final as the one so final? How do we understand the pain someone is feeling?
How do we measure the consequences of not allowing a person to exercise the most basic of human
rights, the right to choose over one's own life? [4, 5]

7.       In closing

After carefully considering the arguments for and against euthanasia, I believe the arguments for
are much sounder. We cannot live in a truly free society unless we give people the power to decide
their own fate in all considerations. In some western countries and most developing countries, we
give the government the power to kill people. Whether as a punishment for serious crimes, as a tool
of internal repressions, or in an act of war. To deny a suffering individual the opportunity to end
their pain, is almost inhumane.

On the other hand there are always problems with misuse, sometimes even abuse of any right. A
careful approach to any benevolent policy has to be considered. Good palliative care could solve
the problem in most cases, but it is not a blanket solution. Also as long as we let religious
reasons stand in a way of scientific and modern moral decision making, any progress will be an
uphill battle. In today `s world, where the talk of the day on every university campus is
marginalised groups, the group of the people who suffer the most is conveniently overlooked. Let`s
look to the future with hope that future generations actually try to solve this issue once and for
all.



Citation resources

[1] PTÁČEK, Radek a Petr BARTŮNĚK. Eutanazie - pro a proti. Praha: Grada, 2012, 256 s. Edice
celoživotního vzdělávání ČLK. ISBN 9788024746593.


[2] KUCHAŘOVÁ, Karolína, 2021. Eutanázie-etické a právní hledisko. Pardubice. Diplomová práce.
Univerzita Pardubice.


[3] HOŠTÁKOVÁ, Kristýna, 2020. Právní a etické aspekty eutanázie. Plzeň. Diplomová práce.
Západočeská univerzita v Plzni.


[4] VÁCHA, Marek Orko. Eutanázie: definice, histore, legislativa, etika. Praha: Grada Publishing,
2019, 112 s. ISBN 978-80-271-2575-3.


[5] EMANUEL, Ezekiel J., 2002. Euthanasia and Physician-Assisted Suicide. Archives of Internal
Medicine [online]. 162(2) [cit. 2022-12-18]. ISSN 0003-9926. Dostupné z:
doi:10.1001/archinte.162.2.142