Euthanasia: A Question of Ethics

Euthanasia is one of the most acute and uncomfortable contemporary
problems in medical ethics. Is Euthanasia Ethical? The case for euthanasia
rests on one main fundamental moral principle: mercy.
It is not a new issue; euthanasia has been discussed-and practised-in
both Eastern and Western cultures from the earliest historical times to the
present. But because of medicine's new technological capacities to extend life,
the problem is much more pressing than it has in the past, and both the
discussion and practice of euthanasia are more widespread.
Euthanasia is a way of granting mercy-both by direct killing and by
letting the person die. This principle of mercy establishes two component
duties: 1. the duty not to cause further pain or suffering; and 2. the duty to
act to end pain or suffering already occurring. Under the first of these, for a
physician or other caregiver to extend mercy to a suffering patient may mean to
refrain from procedures that cause further suffering-provided, of course, that
the treatment offers the patient no overriding benefits. The physician must
refrain from ordering painful tests, therapies, or surgical procedures when they
cannot alleviate suffering or contribute to a patient's improvement or cure.
Perhaps the most familiar contemporary medical example is the treatment of burn
victims when survival is unprecedented; if with the treatments or without them
the chances of the patient's survival is nil, mercy requires the physician not
to impose the debridement treatments , which are excruciatingly painful, when
they can provide the patient no benefit at all. Although the demands of mercy
in burn contexts have become fairly well recognized in recent years, other
practises that the principles of mercy would rule out remain common. For
instance, repeated cardiac resuscitation is sometimes performed even though a
patient's survival is highly unlikely; although patients in arrest are
unconscious at the time of resuscitation, it can be a brutal procedure, and if
the patient regains consciousness, its aftermath can involve considerable pain.
Patients are sometimes subjected to continued unproductive, painful treatment to
complete a research protocol, to train student physician, to protect the
physician or hospital from legal action, or to appease the emotional needs of
family members; although in some specific cases such practises may be justified
on other grounds, in general they are prohibited by the principle of mercy.
Weather a painful test or therapy will actually contribute to some overriding
benefits for him or her, they should not be done.
In many such cases, the patient will die whether or not the treatments
are performed. In some cases, however, the principle of mercy may also demand
withholding treatment that could extend the patient's life if the treatment is
itself painful or discomforting and there is very little or no possibility that
it will provide life that is pain-free or offers the possibility of other
important goods. For instance, to provide respiratory support for patient in
the final, irreversible stages of a deteriorative disease may extend his life
but will mean permeant dependence and incapacitation; though some patients may
take continuing existence to make possible other important goods, for some
patients continued treatment means pointless imposition of continuous pain.
The principle of mercy may also demand letting die in a still stronger
sense. Under its second component, the principle asserts a duty to act to end
suffering that is already occurring. Medicine already honours this duty through
its various techniques of pain management, including physiological means like
narcotics, nerve blocks, acupuncture, and neurosurgery. In some cases pain or
suffering is severe but cannot be effectively controlled, at least as long as
the patient remains sentient at all. Classical examples include tumours of the
throat, tumours of the brain or bone, and so on. Severe nausea, vomiting, and
exhaustion may increase the patient's misery. In these cases, continuing life-
or at least continuing consciousness- may mean continuing pain. Mercy's demand
for euthanasia takes place here: mercy demands that the pain, even if with it
the life, be brought to an end.
Ending the pain, though with it the life, may be accomplished through
what is usually called "passive euthanasia", withholding or withdrawing
treatment that could prolong life. In the most indirect of these cases, the
patient is simply not given treatment that might extend his or her life. For
example, radiation therapy in advanced cancer. In the more direct cases, life-
saving treatment is deliberately withheld in the face of an immediate, lethal
threat-for instance, antibiotics are withheld from cancer patient when an
overwhelming infection develops, since through either the cancer or the
infection will kill the patient, the infection will kill them sooner and in a
much gentler way. In all of the passive euthanasia cases, the patient's