The term euthanasia (derived from the Greek for
good death) has come to mean the deliberate killing
of sick or disabled persons for supposedly merciful
reasons or mercy killing.
The case against euthanasia
SPUC opposes euthanasia because:
it is the deliberate killing of
innocent human beings - a violation of the right
it is contrary to medical ethics, putting doctors
in the role of killers
it assumes that the lives of the gravely ill and
disabled are of less value than the lives of others.
Patient autonomy and the right to life
The case for euthanasia is often argued on the
basis of autonomy--the patient's freedom to make
decisions about his or her own treatment. However,
to invoke autonomy in this way involves a misunderstanding
of the concept of autonomy, overlooking the principle
that the patient's freedom entails a responsibility
to act ethically. While a patient is capable of
giving valid consent, a doctor has no authority
to treat the patient unless that consent is given.
However, the patient cannot ethically refuse treatment
with the intention to bring about his own death.
The ethical objection to suicide is reflected
in law. In Britain, for compassionate reasons,
there are no legal penalties for a person who
attempts suicide, but assisting a suicide remains
an offence. Parliament recognised that people
who have tried to kill themselves need help rather
than punishment. There is therefore no legal right
to suicide, and certainly no right to involve
others in killing oneself. This is because the
right to life is an inalienable right. No one
may dispose of an innocent person's life, and
so one cannot, in justice, intentionally deprive
oneself of life.
If the law were to allow some individuals
to volunteer for euthanasia, this would also threaten
the right to life of others, especially the elderly,
the gravely ill and the disabled. Legalisation of
euthanasia would make a clear statement to society
that it was permissible for private citizens (e.g.
doctors) to kill because they accepted the view
that a patient's life was no longer worthwhile.
If it is seen as a benefit to kill patients who
consent to euthanasia, it is easy to argue that
others should not be denied death simply because
they cannot ask for it. Courts in Britain and other
countries have already judged that some incapacitated
patients may be starved to death and this challenges
the notion that euthanasia would remain voluntary
if allowed by statute law.
Euthanasia versus good medical practice
SPUC's opposition to euthanasia does not mean that
the society insists on medical treatment at all
costs. The alternative to euthanasia is good medical
practice, which requires doctors to recognise when
it is appropriate not to continue treatment.
Sometimes a distinction is made between active euthanasia
(e.g. a lethal injection) and passive euthanasia,
which involves withholding or withdrawing treatment.
However, it is misleading to describe withholding
or discontinuing treatment as euthanasia unless
this is done with the intention of killing the patient.
Sometimes a treatment may properly be withdrawn
even though the patient has consented to it, for
example, when it is futile, merely prolonging the
dying process in a terminally ill patient.
The doctor's intention is the critical distinction
between euthanasia and good palliative care (treatment
to relieve distressing symptoms). The dosage of
painkillers necessary to control a patient's pain
may have the side effect of shortening his life.
No moral objection arises as long as the drugs are
not given with the intention of hastening the patient's
death, but only in order to control the pain.
Tube-feeding and the so-called persistent vegetative
In several countries (including Britain) courts
have authorised the withdrawal of tube-feeding from
patients with severe brain damage who are said to
be in a persistent vegetative state* (PVS). This
amounts to euthanasia if done with the intention
of bringing about the patient's death. Tube-feeding
does not become futile because it is thought that
a patient has no awareness and will not recover,
a judgement which is being increasingly questioned.
Tube-feeding is not usually unduly burdensome, and
only becomes futile if it no longer enables a patient
to receive nourishment. Even if the provision of
food and water require medical assistance, they
are not intended to cure illness but are the basic
means of sustaining life, which it is unjust to
deny anyone on grounds of their disability.
* The persistent vegetative state is increasingly
referred to simply as the vegetative state. The
use of vegetative in these expressions is gravely
misleading since it suggests that a person in such
a condition has somehow ceased to be human.
Advance directives are statements by a patient which
typically contain instructions that, in the event
of certain conditions arising (such as paralysis,
incontinence, inability to communicate, the need
for artificial life support), treatment should not
be given. An advance directive is not necessarily
a request for euthanasia, but such statements can
be used to demand that doctors bring about the patient's
death by, for example, specifying that tube-feeding
should be withheld. For this reason, advance directives,
which, in this context, are often referred to as
living wills, have become an important part of the
campaign of the pro-euthanasia lobby. Legislation
for living wills would facilitate the introduction
of euthanasia, and this is the principal reason
why SPUC opposes moves in Parliament to make advance
directives legally binding.
Doctors might act on an advance
directive in circumstances which the patient did
not foresee, or misinterpret the patient's wishes.
While advance directives may be helpful to doctors
in forming an impression of the patient's preferences,
if they are binding, they are liable to tie the
hands of doctors, preventing them from acting in
the patient's best interests. A patient may not
realise that withholding treatment will not necessarily
lead to an earlier death with less suffering. It
may, in fact, lead to a bed-bound state with greater
impairment of health.
Ascertaining when life ends
The criterion of brain stem death has been used
to determine that death was imminent and inevitable,
so that treatment could be discontinued. However,
there has been a widespread tendency to regard brain
stem death as signifying death itself. Some go further
and suggest that patients with certain forms of
brain damage, such as persistent vegetative state,
should be regarded as dead.
There is increasing concern among pro-life doctors
and ethicists that a patient should not be regarded
as dead until there is evidence of both brain stem
death and the end of other vital functions. This
would safeguard against ending the lives of patients
who had volunteered for organ donation before natural
death had occurred.
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