Ethical Key Issues - Euthanasia

A Duty to Die

With rising healthcare costs, and an aging population, if euthanasia or assisted suicide is legalised, disability activists fear that voluntary euthanasia will soon give way to involuntary or coerced euthanasia. Many health care professionals and bioethicists argue in favour of 'Futile Care Theory,' which measures the value of human life according to the financial cost of keeping the individual alive.


The 'Principle of Double Effect'

This Principle justifies giving pain-relief treatment even if it has the effect of shortening life, provided the primary intention was to relieve the pain, not to kill the patient. Sometimes called Terminal Sedation (TS), when it is used appropriately as palliative care, the patient is sedated and death ensues from the underlying illness, euthanasia opponents point out that this is not euthanasia. Advocates, however, say it is hypocritical to allow TS to relieve pain but not when the intention is to hasten death.


Futile Care Theory and Healthcare Rationing

Euthanasia opponents say that economics is behind the drive to legalise assisted suicide. Many patients with medical and surgical problems are no longer put on waiting lists because of funding issues and New Zealand is facing an expected increase in younger patients with diabetes needing expensive dialysis treatment. Treatment is expected to be rationed, with those not making the list potentially facing palliative care or assisted suicide in the later stages .


Organ Donation and Harvesting

With growing waiting lists and a shortage of donors, some doctors and bioethicists are considering the possibility of further re-defining death and/or providing exceptions to the dead donor rule. This would allow the harvesting of organs from people in a persistent vegetative state or irreversible coma. One bioethicist has suggested that bodies of the dead should become public property so they can be used to make up for the growing shortage of transplant organs.


Autonomy - The Right to Refuse Treatment

While many people fear the loss of personal autonomy in a medical situation and express a repugnance at being kept alive hooked up to a machine, patients have the right to refuse any medical treatment they don't want, and doctors generally accept that decision. What is becoming more common is medical professionals with-holding or withdrawing treatment against the wishes of the patient.


Who makes the decision?

History has shown that once society provides approved guidelines within which it is acceptable to kill another person, it is only a matter of time for those guidelines to be changed and the range of victims extended. Doctors and healthcare authorities are already making decisions to end the lives of patients they deem to have a low quality of life. Opponents of euthanasia say that euthanasia enhances the power and control of doctors, not patients.


Cognitive impairment and euthanasia

People in comas, a 'persistent vegetative stage' with Alzheimer's and Parkinson's patients, the senile, persons with mental illness, the mentally retarded, are all likely to be at some risk if euthanasia is legalised, opponents believe. Bioethicists believe that people such as these place a strain on limited resources, do not qualify as 'persons,' and should be eliminated for the greater good.


The Disabled and Euthanasia

The public and many health professionals, tended to take a far more negative view of being disabled ? than the disabled did themselves. This has led to the formation of disability rights groups who, in many countries around the world, are leading the fight against the legalisation of euthanasia and assisted suicide and say that the provision of in-home, long-term care is crucial to the assisted suicide/euthanasia debate.


Moral Relativism

Moral relativism teaches that there are no absolute moral truths...what is true for you may not necessarily be true for me. It believes and teaches there is no right or wrong, good or bad. Essentially, moral relativism says that anything goes, because life is ultimately without meaning. The opposite view is held by Christians, and followers of many other religions, who believe that humans have an intrinsic value for simply 'being.' If as humans we have no true value, if there is no Creator - no God - then suicide, abortion, infanticide and euthanasia are logically permissable.


Euthanasia of non-terminally ill people

There is much controversy over whether euthanasia and assisted suicide (EAS) should be permissiable for those suffering from depression, chronical illness and other conditions that are not life-threatening. Where EAS is legal, the issue for medical professionals is whether depressed moods should be treated, or should they simply grant the request for euthanasia. Disabled rights groups say that when a depressed disabled person asks for help to die, "all people see is the wheelchair."


Personhood

The debate over 'personhood' is crucial to the issue of euthanasia. Some bioethicists claim that any cognatively impaired human would qualify as a non-person, while others claim that the only living non-persons are Persistent Vegetative State 'PVS' individuals, anencephalics, and probably foetuses. A 'non-person' would not have ethical, or legal rights and protections. Opponents liken this condition to slaves and the victims of the Nazi Holocaust.


The Process of Dying

When dying people were cared for at home, adults and children alike knew what was going on, and the dying person was the centre of attention. Since the 18th century the dying began to be hidden away in hospitals, and the dying person lost control of the process, while doctors battled aggressively to cheat death with medicine and technology. Hospices and hospice home-care are working towards those dying being permitted to have a natural death once again. They are showing that dying, from old age or illness, is simply a final stage of living.