Euthanasia and Pro Euthanasia Ethical Dilemma

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There is no debate that right to life in the Constitution does not include the right to die. It is a settled fact that there is no right to die associated with human life. Although there is no such specific right but the right to die has its roots in the right to live a quality life. Euthanasia is morally justified when the quality of life deteriorates to an extent where one commences waiting for his peaceful and “pleasant” death. Meaning to say that when one finds death far less painful than life, euthanasia can be morally justified. For instance, in a permanent vegetative state (PVS), the patient’s body is able to support him biologically but he lacks any psychological interaction or better understood as his brain is “dead”. This person has a non-existent quality of life due to severe psychological limitations wherein he doesn’t enjoy his life, he is not able to comprehend the very essence of life. In that situation his life loses objective for the purpose of life is to live its experiences and not to survive death. Mere existence without an emotional interaction with the external world does not signify life, that’s existence. Well, if we refute it with the idea that existence although in unconsciousness is a valuable form of living then I can no longer argue. But in my opinion a PVS patient’s life which is deprived of happiness and capabilities loses purpose. It is futile to keep a person alive who doesn’t even know that he is alive. To live you need to be aware of your existence with respect to your surroundings, lungs breathing, heart beating without a mind contemplating does not constitute life. A person struggling with PVS is not like any other bedridden patient with just corporeal agonies, they are living beings who lack the very psychological abilities that distinguish homo sapiens from other creatures.

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The suffering that a person with a terminal illness near to death is subjected to is well depicted in Diane Pretty’s case, a woman who suffered a motor neurone disorder and dreaded the death that patients with her disease generally faced. Although she was mentally healthy her deteriorating condition compelled her to request to the authorities to allow her to die quickly and peacefully without undue suffering. In her case her fatal illness had reached the point where the quality of her life was negatively affected by virtue of her physical disabilities resulting in a condition wherein, she could not enjoy life and contend her wishes. Doesn’t it sound like a sin to force a person to live when he sincerely awaits death with a teary heart? Imagine the plight of the person who does not want to see the next sunrise, who does not care that his death would do him apart from his near ones. He is in excruciating pain, writhing pain that seems unbearable. Life seems irrelevant to him, all that matters is the end to it.

The quality of life argument advocates active euthanasia more than the passive one. If we have accepted the morality of granting a painless death then why don’t grant it in the best possible way. What could be the best possible way? A lethal dosage or injection of medication that would close in his night forever painlessly, would it suffice? It surely would. The best possible way might not seem to involve disconnecting a life supporting device or withdrawing positive treatment that keeps him alive and thus allow nature to take its course. When the outcome is the same then the means does not matter much and hence directing the nature’s course of action by starvation, dehydration or by ancillary infection is a better alternative. Concluding that death is morally desirable why not administer it actively rather than adopting passive techniques?

Apart from the quality of life view there is another aspect to the justification of morality of euthanasia. This approach may be a little difficult to fathom but seems true to me. This argument is from the perspective of the use of limited resources. “When the death of a disabled infant will lead to the birth of another infant with better prospects of a happy life, the total amount of happiness will be greater if the disabled infant is killed.” Let us take a very small scale example for understanding this more clearly. Suppose we have a single resource for instance a single bed in a hospital. A disabled infant who is terminally ill is admitted in that hospital and is undergoing a treatment. But the truth is that doctors know that his illness is incurable and he will ultimately succumb it in later stages. During the same time span there is a pregnant woman who comes to the hospital for giving birth to her child. Ignoring the technicalities of the situation (e.g. there are different wards for the pregnant patients from those of terminally ill people) it is safe to presume that if the disabled infant was actively euthanised then that resource i.e. the bed could be used for the greater good- the birth of a healthy infant. Prolonging the life of the disabled infant with the knowledge that the outcome is nothing but a waste of limited resources. Similarly utilising our limited medical resources to a more fruitful cause is more morally desirable than wasting them on a patient whose expectancy of life is nil e.g. a PVS patient. Financial figures might help in substantiating this argument. If we take a glimpse of the average annual expenditure of PVS patients and then multiply it with the total number of PVS patients the product will shock us and we may consider the desirability of euthanasia once again. Although it sounds ethically gross but it is pertinent to mention herein that for such arguments the teleological approach must be applied rather than the deontologist approach. In other words, the consequences or the end result of our action must be taken into account rather than judging the correctness or the wrongness of our actions in themselves. Meaning that if our actions result in desirable consequences then it does not matter whether those actions are ethically correct prima facie. The action may seem wrong i.e. killing a person is wrong but the end result is always benefitting since a person is saved from a dreadful series of suffering. If we contemplate reasonably and not emotionally then we may prefer investing our finite medical and financial resources in medical research cures more than exhausting them on a bedridden socially and emotionally inactive patients.

Thirdly and most importantly is the argument of personal autonomy i.e. the right to govern ourselves by our will alone. Individuals must have the freedom to make their own decisions with regard to the direction of their lives. No one can be the master of the life of another, except he himself. If the right to direct our lives is vested in our own hands then why not the right to chose how and when to die? The only justified interference in the life of another is to curb that person from inflicting harm upon others. With this view in mind the will of a person pleading euthanasia cannot be interfered with and he must not be denied the right to die. Thus, if we believe in the power and right of an individual to act in a manner which is deemed to be correct then we must not deprive a terminally ill patient from exercising his will to die. This was about personal autonomy. But what about a PVS patient who is incapable of consenting to die? We trust our loved ones in their choices when we are incapacitated. The same goes for a PVS patient, non-voluntary euthanasia may be justified in virtue of properly respecting the decision made by one relative on behalf of another. In such cases the principle of personal autonomy can be extended to familial autonomy.

Till this point I have given favouring arguments for euthanasia. Now I will try to rebut them with some arguments against it. The first objection to euthanasia is based on the Sanctity of Life principle. The sanctity of life ethic propounds that life being sacrosanct has an absolute value to it. An intrinsic value is attached to life and this value cannot be mitigated by any qualitative aspect. Problems in the quality of life cannot negate its ultimate worth. The sanctity of life principle has deontological roots. It emerges from the theory that the action of killing is erroneous irrespective of its consequence and we are dutybound not to kill. In a nut shell life being a sacred gift from God cannot be terminated either by means of voluntary or non-voluntary euthanasia.

The second argument can be associated with Christianity and the Bible. Although it does not sound that relevant from the legal point of view but is worthwhile to be heard while arguing on the moral and ethical dilemma involved in euthanasia. It is the objection from valuable suffering. In Christianity it prevails that the suffering that a person is subject to towards his last days is a part of “God’s saving plan”. If man escaped this suffering, he is deprived of the opportunity to become a person who is closer to the experience of Christ. This suffering is planned by God intending to bring him closer to him. Hence a man should not be freed from this suffering as it helps him come closer to the divine.

The thirdly and most significantly is the argument of the slippery slope objective. This is based on the first two pro euthanasia arguments. If euthanasia is legalised for the common good then isn’t it possible that it applied to situations which are actually morally undesirable. We may go to the extent of allowing involuntary euthanasia also along with voluntary and non-voluntary euthanasia. This would mean that medical professionals would commence adopting euthanasia for a terminally ill patient without his or his family’s consent with the mere purpose to save the finite resources for better utilisation in the future. If the basis of justifying euthanasia is the paucity of our resources and their judicious use then what would require the patient or his family’s consent? If the only issue of concern is the prudent consumption of resources then the free consent of the patient or his family would be immaterial. Aren’t we trickling down to a very hazardous path?

Now I would mention a proposition with regard to the personal autonomy in relation to death. If a PVS patient is granted the right to die as and when he desires, then can the same right be granted to a person battling clinical depression who is totally fit physically? The argument based on personal autonomy can only hold good if the answer to the above posed question is in the affirmative and the answer can never be a “yes”. This would enable the suicide alternative for mentally ill patients. If the basis of justification for euthanasia is personal autonomy then why so that we can justify death for some people and not for others? Shouldn’t there be a uniform criterion?

If euthanasia is shown the green flag for terminally ill patients then aged people of the families would start considering themselves a burden on their kids. This would convince them to follow the same path and accept death for the betterment of their children. Elderly people from well off families would start contemplating that they must die for after their death would save expenses and would allow their children to inherit the accumulated wealth thereafter. This could kill the desire to live in people. They would start overseeing their lives for the interests of their loved ones.

Lastly is the objection from modern treatment. The effect of legalising euthanasia is similar to artificially purging their chance of living an experience likely to cure their condition. Due to technological advancements in medical science there is probability that there could be some new cure effective on terminal illness. But this can only be proved when those with terminal illness are allowed to live upto that extent. If euthanasia is allowed and they are put to early death we will never be able to successfully discover the cure of that illness. Also, with palliative care being enhanced now there are chances that patients with threatening disorders can also be taken good care of by professionals of the medical field. If euthanasia is legalised then there may be probable chance that some deaths may occur for patients who could be cured had they been kept alive.

It’s an endless debate. There are many pro euthanasia arguments and there are numerous ready to negate them. It is a very subjective issue and to reach a conclusive decision is tough. As of now, passive euthanasia is permissible under the Indian law. In the case of Common Cause v. Union of India , the Apex Court has recognized the right to die with dignity as a fundamental right and held passive euthanasia permissible under law. It was declared that the right to die with dignity includes that the process of death in case of a terminally ill patient or PVS patient be smoothened with the purpose to reduce pain.  

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