Euthanasia: Murder or Relief? en

By Xghost on Tuesday 9 December 2014 12:53 - Comments (14)
Category: -, Views: 3.542

Introduction
In many countries, committing suicide and helping someone with committing suicide is considered as an illegal act(1). Moreover, according to most religions, it is seen as a ‘sin’ to do so(2). As religion played an important role in the development of many countries, the actual laws originate partly from said religions(3), causing committing suicide to be an illegal act. In Christianity, suicide is considered as disrespecting the body which was given to you by God(4). In another large religion, the Islam, suicide is also seen as an unforgivable sin(2).

But what if suicide is used as a means for alleviating pain or to escape from endless suffering instead? This way of committing suicide is often referred to as Euthanasia. Euthanasia can be practised in a passive and an active form. Passive euthanasia is a form in which no action is taken to perform the euthanasia, by not prescribing antibiotics, for example, and thus letting the patient die slowly. On the contrary, in active euthanasia, an action is performed, for example giving muscle relaxants and sleeping medicine, causing a patient to die(5).

Since laws and beliefs are differing between countries, euthanasia rates are also differing. While in the Netherlands, 2.59% of deaths are caused by euthanasia, in Denmark and Italy 0.04% and 0.06% respectively are caused by euthanasia(6). A cause of this difference might be found in the fact that the Dutch are more progressive and accepting in taboo subjects like drugs, sex rights, and even euthanasia as it seems.

A moral problem arises if it comes to the practise of euthanasia. On the one hand, performing euthanasia acts against respect for human life, as it can be seen as murder. Besides, euthanasia might be viewed as an act not suitable for medical personnel, as it is not the act of curing but the act of killing patients.

On the other hand, the question is whether a patient with such a bad health and prospect, would even have a worthy life. For example, a man with Alzheimer’s disease in a highly developed state could be seen as a whole other person by his friends and family, as the disease totally changes the behaviour of someone. Moreover, the patient himself is not even aware of the situation his person is in. The life of this patient would be called unworthy by several people, including his family. Would the harm that this situation would bring to the family and friends be of greater severity than the harm of releasing the man from suffering? In addition, could euthanasia be a part of a doctor’s task to care for patients? And in what way would euthanasia differ from murder?

As stated, there are several moral contradictions present when it comes to euthanasia. In this article, this moral problem will be evaluated using a care ethics perspective. First of all, the care ethics perspective, its components and the reason why it is used will be explained. Secondly, passive euthanasia and active euthanasia will be separately assessed along this ethical theory.

Care Ethics
If a moral problem is to be evaluated with the care ethics approach, a normative evaluation is given. In other words, the given care is evaluated whether it is good care or not(7). Besides, the agents on which the given care applies, between the care giver and the care receiver, should be both evaluated, whereas ‘relational autonomy’ is considered as an important principle which has to be taken into account(7). Relational autonomy can be seen as the normal capacity for reasoning, not being blocked by any emotional, psychological or pathological factors(8).

According to Joan Tronto, a care practice takes place only when the four elements of care are present: ‘caring about’, ‘taking care of’, ‘care-giving’ and ‘care-receiving’ respectively. With these four phases, four moral elements are matched: attentiveness, responsibility, competence, reciprocity(9).
The aim of the given care is to fulfil the good of the patient(10), which can be divided in clinical good, the good as perceived by the patient, the good of the patient as a human being, and the ultimate Good.
The care ethics approach will be used in evaluating this moral problem, because euthanasia is not an intrinsically moral act. With the use of virtue ethics or deontology, the moral problem could not be analysed as well as with care ethics, since it would never be the virtue or duty of someone to kill oneself. With the use of care ethics, a normative evaluation is given, which will consider the given care in a doctors and a patient’s perspective.

Ethical evaluation
For this ethical evaluation, a patient who is suffering badly from metastasized cancer is used as a casus. He is considering euthanasia as treatment. First of all, the aim of the care practice will be evaluated.

The aim of care is to fulfil the good of the patient. The question, here, is what the good of the patient who is undergoing euthanasia is. For a patient with metastasized cancer, the clinical good is the best thing that could be done in a clinical point of view. In metastasized cancer, curing the disease is highly unlikely, if not impossible. The only treatment is to delay the disease, and thus delay death. This can come with pain and suffering. So in the end, the clinical good would be resulting in death anyway. There could be said, that there is no clinical good. As for the perceived good by the patient, easing the suffering of the patient is what should be done. The only way of achieving this, is to perform the euthanasia. The good of the patient as a human being, is to be assisted in coping with dying from the disease(10). But what if a patient could not cope with the disease? This could be the case in this casus, resulting in the allowance of euthanasia. The last good is the ultimate Good. This can be seen as the personal beliefs of the patient regarding his spiritual destiny(10). If a patient beliefs that suffering is not the right way of living, and that alleviating the suffering by euthanasia is his destiny, it would be the ultimate Good of him to be euthanized.

As said before, relational autonomy must be present when good care is performed. This means that it must be clear whether the patient who wants to be euthanized, is conscious and aware of the choice he is making. If this is not the case, the euthanasia would not be good care.

Seen from the doctor’s point of view, the care practice must be subject to the four moral elements. As for attentiveness, a doctor must be open to a patient’s needs(10). In euthanasia, this means that a doctor must listen to the patient, and give him the right information to form these needs. In the responsibility domain, the doctor must ensure the neediness of the euthanasia, and if the treatment has started he must ensure that the euthanasia will be practiced. Another moral element which a doctor must have is competence. He must have the competence to inform the patient, be convinced that the patient really wants the euthanasia, and that he can perform the treatment. Lastly, a doctor must ensure that the vulnerability of the patient will not badly influence the process of care.

Conclusion
In conclusion, using the care ethics theory, euthanasia can be considered as a good care, even though it might intrinsically sound contradictory. As long as the patient’s own goods are evaluated well, and the relational autonomy is taken into account, assuring that the true wish of a patient is one of being euthanized. It is the doctor’s task to assure this, and to maintain a good care practice. If all said factors are taken into account, euthanasia can be considered as morally good care



References

1. Gloom. Is Suicide Illegal? Suicide Laws By Country 2014 [cited 2014 30 october]. Available from: http://mentalhealthdaily....-suicide-laws-by-country/.
2. Muslim Public Affairs Council. Religious Views on Suicide. Perspectives from World Religions. n.d. [cited 2014 30 october]. Available from: http://www.mpac.org/progr...ious-views-on-suicide.php.
3. Rasor PB. Biblical Roots of Modern Consumer Credit Law. Journal of Law and Religion. 1993;10(1):157-92.
4. Stephen Smith. 52 Bible verses about Suicide: OpenBible.info. ; 2014. Available from: http://www.openbible.info/topics/suicide.
5. Nancy Ann Silbergeld Jecker, Albert R. Jonsen, Robert A. Pearlman. Active and Passive euthanasia. In: Learning JB, editor. Bioethics: An Introduction to the History, Methods, and Practice1997. p. 77-82.
6. van der Heide A, Deliens L, Faisst K, Nilstun T, Norup M, Paci E, et al. End-of-life decision-making in six European countries: descriptive study. The Lancet. 2003;362(9381):345-50.
7. Marian A. Verkerk. The care perspective and autonomy. Medicine, Health Care and Philosophy. 2001(4):289-94.
8. Stoljar N. Feminist Perspectives on Autonomy 2013. Available from: http://plato.stanford.edu/entries/feminism-autonomy/#RelAut.
9. Tronto J. Moral Boundaries: a political argument for care. New York: Routeledge; 1994.
10. A. van Wynsberghe, C. Gastmans. Telesurgery: an ethical appraisal. Journal of Medical Ethics. 2008:1-6.

Volgende: Lung cancer policy & care in the Netherlands 02-'15 Lung cancer policy & care in the Netherlands
Volgende: The Delay Day 05-'12 The Delay Day

Comments


By Tweakers user Hann1BaL, Tuesday 9 December 2014 13:31

To add to the cause of death data you presented: I do believe the numbers are incorrect. THe amount of deaths by passive forms of euthanasia in countries that do not allow it is most likely substantial. However, you will not find this in any data as it cannot be the official cause of death.

Morphine overdose, stop providing water and food to someone in a coma, are well-known used forms of passive euthanasia.

What it demonstrates is that in countries without any form of regulation you see movement in a grey area.

To my opinion far more countries need to allow it, under strict regulations, to prevent the use of passive, unregistered euthanasia.

By Tweakers user Wailing_Banshee, Tuesday 9 December 2014 15:21

Hann1BaL wrote on Tuesday 09 December 2014 @ 13:31:
To my opinion far more countries need to allow it, under strict regulations, to prevent the use of passive, unregistered euthanasia.
And to shorten the suffering. I'd presume withholding water from a coma patient will cause more suffering than giving him morphine and a muscle relaxant (morphine overdose is not really a passive form, as that can only be done by qualified personnel and I know from first hand experience that countries (Spain in my case) that don't agree on euthanasia won't give a morphine overdose)

The biggest problem with this is permission from the patient. What if the patient can't make his wishes clear? And also, when is endless endless? What if you make the decision to end the suffering and the next year the miracle cure is found.

It'll never be an easy choice to make, nor should it ever. But I agree with Hann1Bal that it should be legalized, under strict regulations.

By Tweakers user Helixes, Tuesday 9 December 2014 18:19

I would want to start with my appreciation for such an elaborate piece on euthanasia from a healthcare perspective. I would fully agree that euthanasia and healthcare could pose a contradiction. However, the urgency to deal with death, or, when necessary, the advancement thereof, is almost inevitable. I know of few healthcare professionals active in fields in which they are confronted with hopeless suffering who haven't been tempted by offering a humane way out, legal or no.

Rightfully, you state that suicide is often considered an illegal act. It is, in fact, not in The Netherlands, although coercion or assistance (outside of the proper medical setting) is. There is a strong connection between (predominantly Christian) theology and the legality of suicide - probably stemming from a debate regarding the ownership of life and/or soul. The Christians pleading it belongs to God, and the right to take it must be His and His alone. A more secular or philosophical approach would show that if anything, your life is the first and last thing a person owns, and could ultimately be taken, if so wished. Of course, there are a lot of intermediates and differences of opinion on the matter - and I would have liked to have seen you take a stance on this particular matter somewhere in your blog.

Also, as has been pointed out, the black and white matter of ultimate self-determination becomes a rather grey area when a person falls critically ill, and doubt can be cast on the capacity this person is left with to decide on such an important matter. Equally, a person has the right to decide to be euthanize when faced with a certain threshold quality of life. However, once that state has been reached, the limited or incapacitated consciousness this person is left with might disagree with such a previous decision. Even though he might not be able to express such altered wishes. What is the right thing to do? Should close relatives have a say?

Again, I enjoyed reading your rather intricate piece on euthanasia. However, it has been legal for twelve years now here in The Netherlands. Regardless, it's a matter that has been part of public debate ever since. I would be really interested in reading a follow-up on where we stand after twelve years of experience on the matter. What lessons have been learned? Or, what challenges need to be dealt with as far as the current system goes?

By Tweakers user Barleone, Tuesday 9 December 2014 22:25

Even een knuppel in een hoenderhok gooien: de medische wetenschap heeft zelf van dit dilemma een wereldwijd groot dilemma gemaakt. Voormalig was dit helemaal geen maatschappelijk issue, men kon een lichaam niet als kasplantje in leven houden. De mens ging op een niet te bepalen moment dood.

Nu echter zijn de ontwikkelingen zo ver om de dood uit te stellen dat de pijn van leven groter wordt dan de pijn van een sterfgeval. Dan groeit het dilemma: lijden in leven of lijden in dood.

Zonde betekend: doel missen. Leven heeft "(blijven) leven" als doel. Moord is anti. Express dat doel missen, met voorbedachte rade.

Zelfdoding is een woord wat je eigenlijk alleen mag en kan gebruiken bij ťťnzijdige ongevallen of zoiets. Helemaal niet met voorbedachte rade je eigen leven ontnemen. Dat is en blijft zelfmoord.

PS omdat het niet direct ontopic is: zelfmoord door een christen is vaak niet helder gelovig overdacht. Want eigenlijk zegt zo iemand: God, U kan hoog en laag springen, maar ik kom nu de hemel in, of U nou wil of niet. (want: de hel zal zo iemand toch niet denken in te gaan??? aangezien diegene zeker denkt te weten van lijden verlost te zijn. Een christen die niet in de hel gelooft heeft namelijk 0 redenen om in Jezus Christus te geloven. Hij kwam speciaal om onze hel-straf te dragen, zodat wij door geloof vrij de hemel in mogen.)

E.e.a. zijn gedachten die in mij opkomen. Er staat vast iets leerzaams tussen. Ook in de christelijke zorg wordt overigens hard nagedacht over wat er ethisch verantwoord medisch handelen is, en wat niet meer. De grens is echt niet makkelijk te vinden.

[Comment edited on Tuesday 9 December 2014 22:46]


By Tweakers user link0007, Wednesday 10 December 2014 02:56

Barleone wrote on Tuesday 09 December 2014 @ 22:25:
Even een knuppel in een hoenderhok gooien: de medische wetenschap heeft zelf van dit dilemma een wereldwijd groot dilemma gemaakt. Voormalig was dit helemaal geen maatschappelijk issue, men kon een lichaam niet als kasplantje in leven houden. De mens ging op een niet te bepalen moment dood.
Alsof mensen toen niet een leven lang pijn konden lijden. Er zijn genoeg aandoeningen die niet dodelijk zijn, maar wel uiterst pijnlijk.

[quote]
PS omdat het niet direct ontopic is: zelfmoord door een christen is vaak niet helder gelovig overdacht. Want eigenlijk zegt zo iemand: God, U kan hoog en laag springen, maar ik kom nu de hemel in, of U nou wil of niet.

Onzin. Je neemt nu aan dat mensen direct de hemel in gaan na de dood. Dat is echter absoluut niet waar in het christendom (Łberhaupt niet in de Abrahamitische religies), vanwege het bestaan van de Dag Des Oordeels. Pas dan wordt men beloond voor hun levenswandel, en pas dan gaat men dus naar de hemel.

[Comment edited on Wednesday 10 December 2014 02:58]


By Tweakers user RadioKies, Wednesday 10 December 2014 12:26

Incoming brainfart:
Good post, but I think you had a big focus on only rational thinking and almost nothing from the religious side, even though you started with a line about religion and development.

"As religion played an important role in the development of many countries"
To what are you referring? Religion brought the dark ages, the time period where progress in evolution was halted and even brought back "to the stoneage", hence the dark age.
http://d3ct8f39dj9jhs.clo...oads/2014/04/darkages.gif

Thats just development on a scientific level. When looking at people what has religion brought us? A way to supress people into a following and to wage war. Religion is in my opinion another word for fear. Especially hell is a nice fear mechanic. This pictuse shows why one should not believe in a Hell or something not heavenly:
http://i.imgur.com/a2Ja4HR.jpg
Lets assume there is a God, why would he refuse to let people like Bill Gates to enter? Bill and his wife Melinda Gates are probaly the biggest saints there are today and maybe even of all time in history. Having fun in life and using all their wealth to help people all over the world. Did Ghandi and mother Theresa go to heaven? If so, why? Because they are saints? They are not pure good people... they are also responsible for making people suffer, so why are they saints and do they get to go to heaven?

Laws are made so people know whats wrong or whats right. Laws are not set in stone (not even if there are 10 :+ ). A law can be changed over time as we progress and learn more/new things. New things are discovered and laws are adjusted (or should be at least) with time. Just like how some laws are not covering the digital/internet age like privacy.

There are still a lot of laws that are influenced by religion and like you siad the law about euthanasia is formed by belief. If you discard religious reasons you'll keep a few reasons that someone should consider, but at least it's not a no go at all times.

Disclaimer: I've been raised as a Catholic Christian and my schools (basic, middle, mbo and hbo) have been religious. Untill my ~12th year (maybe even younger) I've been visiting chrurch and after that I started to question all the stories and beliefs coming from religion. I see myself as an agnostic atheist. Mostly because I can't think of a deity that would allow living creatures (not just humans) to suffer and allows the Vatican to excist. The bible is also in no way credible. i.e. How could a deity kill all firstborn children from a people if their supreme ruler would not listen to it? Didn't god make humans with flaws, and isn't that why we have the saying 'to error is human and you have to learn from your past mistakes'? Why punish people in such an extreme way for the fault (that he created in the first place) of one person? He certainly can't blame the people for listening/following someone with more power, because thats the same as what god expects of the people to do for him.
Barleone wrote on Tuesday 09 December 2014 @ 22:25:
(want: de hel zal zo iemand toch niet denken in te gaan??? aangezien diegene zeker denkt te weten van lijden verlost te zijn. Een christen die niet in de hel gelooft heeft namelijk 0 redenen om in Jezus Christus te geloven. Hij kwam speciaal om onze hel-straf te dragen, zodat wij door geloof vrij de hemel in mogen.)
Met die gedachtegang kunnen wij ook stellen dat Jezus voor onze zonden is gestorven, als een mens dan niet zondigd dan is hij voor niets gestorven. Als je zondiging is door euthanesie the plegen of aan zelfdoding te doen dan ben je toch alsnog vrij om naar de hemel te gaan?

By Tweakers user link0007, Wednesday 10 December 2014 14:40

RadioKies wrote on Wednesday 10 December 2014 @ 12:26:
Incoming brainfart:
"As religion played an important role in the development of many countries"
To what are you referring? Religion brought the dark ages, the time period where progress in evolution was halted and even brought back "to the stoneage", hence the dark age.
http://d3ct8f39dj9jhs.clo...oads/2014/04/darkages.gif

Thats just development on a scientific level.
It is also completely wrong from a history of science perspective. For one, the dark ages were essential for the creation of academic institutions with structured scholarly research and debate.
Furthermore, after the 13th-century renaissance and the consequent 1277 condemnations, both of which had a thoroughly religious character, the climate for researching hypotheticals, thought experiments and systems of the world only really took off. It is not without reason that Duhem famously dubbed the 1277 condemnations "the start of the scientific revolution".

Then, with the real renaissance following not long after, the innovations in science were again done by religious institutions and with religious motivations. Not only the novatores, but also Copernicus, Bruno and Kepler were all very religious - to name but a few well-known names.

Later on, it were again the religious motivations which played such a vital role for Gassendi, Descartes, Pascal, Newton, Leibniz. Even the Royal Society began with a theological mission in mind: to study the work of God in nature. Do not forget that Robert Boyle, a central figure in the early Royal Society, was an avid amateur theologian.

Only with Spinoza and Hume do we see moderately clear atheistic thoughts - but none of these early atheists was much more revolutionary than their religious counterparts - especially not in empirical sciences.

Only after Hume does the atheist population of scientists grow, and even then it is largely through the still very christian universities.

So please, explain how religion caused the dark ages. Because it sure does not seem like you know an awful lot about the history of science.

By Tweakers user Helixes, Wednesday 10 December 2014 20:39

I don´t think it´s fair to credit or discredit Christianity in the pre-renaisance world. The Bible and its derivatives were indeed the de-facto standard work on natural history, wrong as that may sound today. The entire civilization in Europe was permeated by theocratic thinking. Every single last brilliant mind of that age was bound to have been exposed to Christian (or Judaic) doctrine and what we would call propaganda now. As such, they were pretty much all convinced of Christian (or, again, Judaic) virtues - or upheld that they did anyway. The stories of those few souls who freed themselves from such dogma didn't end well.

You name Descartes as a philosopher with religious motivations. I am not quite sure that he had. Reading his work, it must be clear that - if anyone else - he disbanded "the old way" (ie, Christian thinking), in favour of free thinking. I don't believe we will ever know whether he indeed died the devout Christian he purported to be. He had enough trouble with institutionalized Christian dogma as it was (in Utrecht, for instance). Regardless, let's not forget that there wouldn't be a Hume without Descartes. And the French revolution (and, with it, the notion of secularism) would have had quite a different face if it hadn't been for Descartes.

Still. However you put it, and this discussion appears to prove this, euthanasia and religion are strongly intertwined. It's hard to talk about euthanasia without discussing its history, which is bound to touch on religion. I would want to be as bold as to state that secular thinking has won that debate, at least, in The Netherlands. Regardless, the experiments we have started here are still quite new. There have been a few challenges since legalization - among which an apparent increase in incidence, as well as a gliding scope of applicability. Personally, I would be much more interested in a discussion regarding those matters :)

By Tweakers user _Garu_, Thursday 11 December 2014 12:22

Views on euthanasia seem to crossing paths with religion almost with certainty.. However why religion or mindset of others should prevent someone from requesting and receiving euthanasia is beyond me.

Let me demonstrate this with some examples:
- A person with cancer, no further treatment applicable or available, enduring constant pain
- A person who views life with dementia as living like a plant, who in good mental health requests for euthanasia in a certain health or mental state, notarized.
- A person with cluster migraine or other terrible headaches which prevents normal life or work, thus forced into a life as a social and economic outcast

For me all these examples and more should be eligable for euthanasia..
It should be their choice and no religious, political or medical related person should be able to protest these people from euthanasia, assisted or self-inflicted.

In my opinion people should be able to decide for themselves what is enough quality of life.

By Tweakers user link0007, Thursday 11 December 2014 15:02

Helixes wrote on Wednesday 10 December 2014 @ 20:39:
You name Descartes as a philosopher with religious motivations. I am not quite sure that he had. Reading his work, it must be clear that - if anyone else - he disbanded "the old way" (ie, Christian thinking), in favour of free thinking.
You cannot just reduce the dominant ideas of his time to 'christian thinking'. Especially in the case of Descartes, the Bible was not a key constraint. In fact, his entire philosophy depended on the existence of a benevolent and omnipotent creator to escape the problem of solipsism and skepticism.
The primary constraint for Descartes (and all of the other great philosophers of that time) was the Aristotelian doctrine. They were hindered by Aristotle, and their greatness consisted in moving past Aristotle.

But of course, accepting that fact would clash with the anti-religious narrative which has so carefully been constructed by the Enlightenment.

By Tweakers user i-chat, Friday 12 December 2014 02:54

Wailing_Banshee wrote on Tuesday 09 December 2014 @ 15:21:
[...]


The biggest problem with this is permission from the patient. What if the patient can't make his wishes clear? And also, when is endless endless? What if you make the decision to end the suffering and the next year the miracle cure is found.

It'll never be an easy choice to make, nor should it ever. But I agree with Hann1Bal that it should be legalized, under strict regulations.
there are only bad choices, when you leave someone alive hoping for cure that's never found, or wone you help someone to die and some treament is found, and who is to say that this magical cure doesn't in the end make things ...

cocaine used to be a medicinal drug

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