Physician-Assisted Suicide: A Comparison of Passive and Active Euthanasia Laura M. Cotter PHIL 3520 November 22, 2010 As a healthcare professional, I am well acquainted with the constant struggle to prolong death for oneâ€™s patients. It is easy to get attached to these people you sometimes see more than you see your own family. I hope that I am always in a position to give my patients whatever care they may need. At the same time, however, I could not morally, actively assist them in committing suicide, even if they were in a great deal of pain. This does not mean that I think they should not have the decision to end their suffering if they so choose but simply that I see a moral distinction between passively withdrawing life sustaining treatments and actively administering lethal drugs. For me, it comes down to letting nature take its course versus killing someone that I have grown to love and wish to have more time with. I know that there are many critics of this line of reasoning. I will attempt to use the works of Gerald Dworkin, John Arras and others to fully investigate whether or not there is an ethical difference between passive and active physicianassisted suicide. Before a serious discussion about euthanasia and physician-assisted suicide can begin, we must define the terms we are to use. Every philosopher has their own preferred terms, such as active or passive, direct or indirect, voluntary or involuntary, positive or negative, and so on. In this paper I will use passive euthanasia to refer to any time that a patient is allowed to die, either by the withdrawal of treatment or withholding of treatment from the start. This applies to either when a patient is conscious and asks for assistance or when the patient is comatose and either the family or physician decides it is
the best decision. Active euthanasia is where the patient is given lethal medication or takes his own life. Again, this can be with the patient’s consent or if the family or doctor deems it necessary in the case of an incompetent patient. I will not argue the differences between voluntary and involuntary forms of euthanasia as generally the arguments for or against can be used in either case. There is generally little controversy in the case of involuntary passive euthanasia when the patient is pronounced brain dead and there is no hope of recovery. In fact, it would seem almost insane to insist that we do everything possible to keep a person’s body functioning when that essential humanness is gone. Once the argument against this now common practice was that physicians were “playing God.” However, now we are also “playing God” by treating people with illnesses that would have killed them half a century ago. This argument is obsolete because, as Joseph Fletcher says, “That God, seriously speaking, is dead.”1 Now we must ask if there is any real moral difference between turning off the organs of a lifeless body and giving lethal medication to a cancer patient who may still have months or even years to live. One of the most common arguments against active euthanasia is the Hippocratic Oath that physicians take and where it states that the physician to never harm their patient. It is common knowledge that the Hippocratic Oath physicians take today is not the same as the one taken by the ancient Greeks. Our knowledge of medicine has changed and therefore our ethical standards must change with it. Moreover, an oath does not ethically bind a physician or other person to one course of action and only that course of action. A code should support the ethics that are already in place, not force individuals to change their moral standards to fit the code. If there is a conflict between a person’s
morals and the code, they may choose to override the code at any given time. Oaths are also not the bottom line on ethical issues. Every parent has certain moral obligations to their children yet parents do not take an oath upon the birth of a child.2 In this light, the argument against euthanasia on the grounds of breaking the Hippocratic Oath is very weak. Those who use the Hippocratic Oath argument will try to say that passive euthanasia is allowed by the code since the physician is technically not doing anything to the patient, therefore he cannot be harming him. This is the argument of the absolutist who believes there is a clear line between letting a patient die and killing him.3 It is always wrong to kill an innocent person. Letting an innocent person die, however, may not always be wrong, especially if it is just an unintended effect of an action that was intended to be good. By removing the patientâ€™s feeding tube or prescribing high amounts of opioids for pain relief the physician is not necessarily intending for the patient to die. The physician could argue that they merely intended to make their patient comfortable even though they knew that the consequences would almost certainly mean death. This argument that the rationalization of euthanasia by what was intended to happen is not very convincing. We can all say that we never intended for something bad to happen even though we knew the chances of it happening were high. In the end, whether admittedly intended or not, the physician is still the one who decides when, how, and where the patient dies.4 On the other end of the spectrum, the consequentialist point of view is that if the consequences are the same, it does not matter how those consequences come about.3 Therefore, there is absolutely no moral distinction between active and passive euthanasia.
Yet this is still not entirely true. By actively taking oneâ€™s own life, with or without assistance, there will be others who are also affected, and even harmed, by such actions. To commit suicide is to decide that your life no longer has meaning to you or to anyone else. Obviously this is never true. We are always interacting with others and we may not know the full extent of our influence on them. It has been scientifically shown that when a patient dies in a hospital, those left to grieve their passing are more than twice as likely to die within a year than those whose loved ones were allowed to pass quietly away at home.5 I find myself more on the consequentialist side of the argument for most cases of active versus passive euthanasia. I agree that patients have the right to choose how to live, or not live, their lives. I do not want anyone interfering with me so I have no right to interfere with the life of another. At the same time, one cannot say that passive and active euthanasia are always the same thing. Motives and intentions do play a part. It is more wrong for a physician to let a patient die because they simply do not like the person than it is for a physician to assist a beloved patient and friend slip peacefully into death. The consequences of active and passive euthanasia are the same: either way a physician brings about a patientâ€™s death sooner than it would come about on its own. The motives behind such action or inaction can be vastly different. I cannot say that motives are more important than consequences or vice versa. Rather, I believe that they are equally important and should both be taken into consideration. Eventually, all arguments come down to whether life or freedom of choice has the higher value. There is no clear answer to this dilemma. If freedom of choice is greater, must we always step back and allow others to take their lives if they so please? I would
argue that this is unacceptable to most rational individuals. Adolescents who attempt to commit suicide may not always fully understand the consequences of their actions and so we try to stop them and then help them find treatment. When can we allow a person to choose? Is there a specific point where someone’s life is suddenly meaningless and so they may commit suicide or ask their physician to assist them? I know I am not capable of deciding whether a stranger’s life is meaningless or not but I will try to help someone that is in mortal peril if I can. None of us know exactly how much another person’s life means to them, their family, their friends, or anyone else who has had or will have interaction with them. We can only act based upon instinct and past experiences. On the opposite end, some would argue that our lives are not actually ours to do with as we please. We did not actively create our own life. It was a natural process that allowed us to come into being. If we did not create our life, we do not own our lives and we must respect the intrinsic, basic value of all human life, with no life being more or less meaningful than another. Each person must decide for themselves whether life or freedom of choice is more important. In a perfect world we would be able to allow every person to make their own choices so long as they did not harm another or restrict another’s free will. This world is far from perfect in reality. The truth is that we cannot assure that euthanasia, passive or active, will not be abused. I find that unwanted or coerced death is too high a cost to pay for the choice of how and when we die. There are obviously exceptions to this as there are to everything in life. Do we allow the exceptions to be the rule? In a country that is based upon the voice of the majority, I say no. I do hope, though, that at some point in the future our society will have evolved to a point where we do not fear physicians or
hospitals forcing euthanasia on a patient due to financial reasons. If that day comes, I will lend my voice in support of legalizing physician-assisted suicide. For now, however, I will continue to take care of my patients and help them the best way I know how, by helping them to live.
References 1. Fletcher, J. (1977). Ethics and euthanasia. Ethical Issues in Death and Dying. New York: Columbia University Press, 348-359. 2. Dworkin, G. (2002, April). Patients and prisoners: The ethics of lethal injection. Analysis, 181-189. 3. Ladd, J. (1979). Positive and negative euthanasia. Ethical Issues Relating to Life and Death. New York: Oxford University Press, Inc., 164-186 4. Arras, J. (1997). Physician-assisted suicide: A tragic view. Journal of Contemporary Health Law and Policy, 361-389. 5. Lasagna, L. (1970). The prognosis of death. The Dying Patient. New York: Russell Sage Foundation, 67-82.