Excerpt
The Oxford English dictionary describes Euthanasia as “The painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma”.[1] The act of Euthanasia is legal in only three countries in the world, all of them are European Union member states namely the Netherlands, Belgium and Luxembourg. But the number of citizens seeking the act of Euthanasia in their home countries is increasing yearly. Assisted Suicide is described as “Suicide effected with the assistance of another person, especially the taking of lethal drugs provided by a doctor for the purpose by a patient suffering from a terminal illness or incurable condition” by the Oxford English dictionary.[2]
Recently in the Republic of Ireland a case was brought against the state by a sufferer of multiple sclerosis Marie Fleming. Mrs Fleming brought forward the argument that Section 2(2) of the Criminal Law Suicide Act 1993 should be declared invalid under the Constitution and incompatible with the European Convention on Human Rights. Mrs Fleming wished to be assisted in dying at a time of her choosing by her partner with out fear of criminal sanctions on her partner afterwards, in order for this to be possible Mrs Fleming had to be successful in arguing that Section 2(2) of the Criminal Law Suicide Act 1993 should be declared invalid under the Constitution and incompatible with the European Convention on Human Rights. However Mrs Fleming was unsuccessful with the Supreme Court rejecting her arguments.[3] After this judgement was passed down Marie Fleming wrote an open letter to the country saying “If the people who makes the decisions won’t listen to me I would ask them to come live my life for just one day or even one hour and tell me how enthusiastic they would be about living it seems they will not give me permission to die but they will not help me live either.”[4] “I tolerate a lot and I don’t ask much all I ask is to be allowed make my decision about death and to be given the help that I need to carry out my wishes”.[5]
Philosopher John Stuart Mills in an attempt to describe utilitarianism created the greatest happiness principle which describes happiness as “a desirable either for the pleasure inherent in themselves, or as a means to the promotion of pleasure and the prevention of pain.”[6] John Stuart Mills received numerous objections to his principal. It was argued that the principal was merely just a epicurean hedonism meaning its sole goal was pleasure Mills rebutted the argument stating that utilitarianism is concerned with quality not only quantity and that a sense of dignity was proportionate to higher facilities.[7] It was also maintained that happiness is unattainable to which Mills responded that utilitarianism aims not only at happiness but at the prevention of unhappiness and the avoidance of pain.[8] It was also suggested that utilitarianism is godless to which Mills counter argued that Religion is in general about acting morally.
If we were to relate John Stuart Mills’s theory and various his supports of the theory back to the Fleming case and the argument of whether the use of Euthanasia and or Assisted Suicide can be beneficial or unbeneficial to society on a medical, moral and ethical basis I feel strongly that we would find that it benefits society. In the Fleming case we are presented with a fatally ill woman wishing to end her own life through assisted suicide. It is indisputable after reading the quotation’s from Mrs Flemings letter to the state that it is a letter being written by a woman who has be raped of her human dignity, whose happiness has been extinguished and whose morality is firm. Mrs Fleming’s happiness is non-existent but her pain is real, she is not living a life of quality but instead she is merely existing as a quantity on earth and she is attempting to act in a moral manner in respect to her human dignity, her families’ dignity and her self-belief.
While the act of Assisted Suicide is not constitutionally protected in Ireland it is protected in other parts of the world such as Montana in the United States of America. In October 2007 a challenge against the laws on assisted suicide in the state of Montana were brought forward by two terminally ill patients, four doctors and a patients’ rights organisation to the District Court claiming the right to privacy and human dignity. It was alleged that the “application of Montana homicide statutes to physicians who provide aid in dying to mentally competent, terminally ill patients” contravened with article 2 of the state’s constitution which protected the right to privacy and human dignity. The District Court held that the constitutional protection of these rights included the right for competent, terminally ill patients to die with dignity and so found that this right was therefore to include protection from prosecution for a physician who might assist such a patient.[9]
Within the medical world it has been debated time and time again that the need for Euthanasia and or Assisted Suicide is tenuous as other measures such as palliative care and DNR’s are widely available to control the pain and suffering being experienced by sufferers with incurable and painful diseases. Palliative care is described as the prevention and relief of suffering by means of assessing and treating pain and other physical, psychosocial or spiritual problems,[10] and while there is no strict definition for a DNR it means that should a patient suffer from cardiopulmonary failure CPR should not be attempted.[11] Brigit Taylor and Robert McCann MD of the University of Rochester distinguish between the uses of controlled sedation to relieve intolerable suffering and active euthanasia, defining controlled sedation as the use of medication to bring a patient to the point of unconsciousness to relieve intolerable suffering before an inevitable death, but not to hasten or bring about death.[12] While the use of sedation lessens the pain and suffering being experienced by a sufferer it does not act as a cure for an incurable disease and does not prevent inevitable death in these circumstances. While the use of Euthanasia does not cure incurable illness’s either it does end all the suffering and pain being experience by a patient whose death is near and inevitable. Many physicians express their wish to respect a patient’s desire for euthanasia or Assisted Suicide in an act of compassion for the pain and suffering being experienced by his or her patients. Physicians believe they are called on to care and when they cannot cure, some contend that when caring for a patient who is experiencing unbelievable pain or some other form of unbearable suffering includes acceding to a request for euthanasia.[13] Thus making this a question of morality more so than fact in my personal opinion.
Kant believes moral values are concerned not with actions which are seen but with their inner principles which are not seen.[14] While the act of Euthanasia results in intentionally ending a life, said life is ended to relieve extreme pain and suffering. While the action itself is shortening a person life by accelerating their death the inner principles of the act result in a patient suffering from extreme pain to be no longer experiencing such anguish. It must also be taken into consideration that the death of the patient suffering from an incurable disease is inevitable. Kant also distinguishes between two types of imperatives hypothetical and categorical imperatives. Kant believes hypothetical imperatives to be of practical necessity of action as a means for attaining something else meaning they only apply to people who want to achieve the goal to which they refer[15] on the other hand Kant believes categorical imperatives are actions which are objectively necessary in itself without reference to another end.[16] Kant believes that categorical imperatives, unlike hypothetical imperatives tell us what to do irrespective of our desires.[17] Therefore in the case of the use of Euthanasia or Assisted Suicide it could be argued that the use of such an act is a categorical imperative to end a patients extreme pain and suffering from an incurable disease and accelerating the death process thus making the act morally acceptable on a moral and ethical basis. Philosopher John Stuart Mills in an attempt to describe utilitarianism created the greatest happiness principle which describes happiness as “a desirable either for the pleasure inherent in themselves, or as a means to the promotion of pleasure and the prevention of pain”. In Stuart Mill’s early essays he relates back to an earlier philosopher Bentham who makes the point that a man is not really virtuous unless the mere thought of committing certain acts is so painful that he does not even consider the possibility that they may have good consequences, Mill’s supports this point made by Bentham and later repeats it in his system of logic and utilitarianism.[18] The act of performing Euthanasia or Assisted Suicide is undoubtedly an emotionally painful act to commit but by committing it good consequences occur. A patient’s pain and suffering from an incurable disease cease’s, the patient’s human dignity is preserved and their right to privacy is restored.
If we were to relates both Kant’s and Mils theory back to the question as to whether the use of Euthanasia and or Assisted Suicide is a necessity when other services such as palliative care and DNR’s are available to counter act the symptoms experienced by sufferers with incurable diseases and the argument of whether the use of Euthanasia and or Assisted Suicide can be beneficial or unbeneficial to society on a medical, moral and ethical basis I firmly feel the act of Euthanasia and or Assisted Suicide would benefit society. With the support of both Kant’s and Stuart Mills philosophical theories I have been able to support the morality of the act of Euthanasia and Assisted Suicide, the inner principles relating to Euthanasia and Assisted Suicide, the thought process and the good consequences that may occur from the acts of Euthanasia and Assisted Suicide being performed.
One of the main arguments against creating new legislation in relation to the acts of Euthanasia and Assisted Suicide is that it would be too difficult to regulate but it must be considered when making this arguments the countries and states that have already enacted legislation in relation to this matter. Take for example Assisted Suicide legislation in the state of Oregon, in November 1994 Oregon voters passed the death with dignity act which allowed terminally ill adult resident’s with a prognosis of less than six months to live, to obtain a prescription for medication for the purpose of ending their own life. A number of conditions had to be met before such a prescription could be prescribed by a physician.[19] It required that:
1. A patient must make two oral requests at least 15 days apart and one written request for medication. The written request must be signed before two witnesses and criteria are outlined in the law regulating who may be witnesses. Forty-eight hours must elapse between the written request and the provision of a prescription.
2. A second medical opinion is required.
3. The patient has to be capable, meaning that in the opinion of the court or in the opinion of the patients attending physician or consulting physician, psychiatrist or psychologist, a patient has the ability to make and communicate health care decisions to health care providers, including communication through persons familiar with the patient’s manner of communicating if those are available.
4. If either of the physicians is of the opinion that a patients judgement may be impaired by a psychiatric or psychological disorder or depression the physician must refer the patient for counselling and can not prescribe medication to end the patient’s life until it is determined that the patients judgement is not impaired.
5. The physician must verify that the patient is making an informed decision, which is defined in the statute as a decision based on an appreciation of the relevant facts and made after the patient has been fully informed by the attending physician of:
- Their medical diagnosis and prognosis;
- The potential risks associated with taking the medication prescribed;
- The probable result of taking the medication that is to be prescribed; and
- The feasible alternative including but not limited to, comfort care, hospice cars and pain control.
6. The physician must request that the patient inform their next of kin of their request for a prescription, though the physician cannot obligate an individual to do so.[20]
Legislation passed in February 1993 ensured that as long as certain guidelines are followed those who practice euthanasia in the Netherlands will not be prosecuted.[21] The guidelines are as followed:
1. The patient must repeatedly and explicitly express the desire to die.
2. The patient’s decision must be well informed, free and enduring.
3. The patient must be suffering from severe physical or mental pain with no prospect of relief.
4. All other options of care must have been exhausted, or the patient must have refused other available options.
5. The euthanasia must be carried out by a qualified physician.
6. The physician must consult at least one other physician.
7. The physician must inform the local coroner that the euthanasia has been carried out.
As we can see the criteria set out by the death with dignity act for Physician Assisted Suicide in the state of Oregon in the United States of America and the guidelines set out for the procedure for Euthanasia in the Netherlands are very alike. Both ensure the patient is properly informed, that all other options have been explored and made available to the patient and that the decision is entered into freely and without undue influence or duress. These guidelines created and enforced by the two different states prove that laws in relation to acts of Assisted Suicide and Euthanasia can be implemented correctly and used accordingly in a manner that will benefit society on a medical, moral and ethical basis by allowing those with terminal illnesses the right to privacy when dying and the right to preserve their human dignity.
While the Republic of Ireland have not as of yet attempted to create new legislation or amend existing legislation in relation to the acts of Euthanasia or Assisted suicide our neighbours England and Wales have. While Euthanasia is still unlawful throughout the United Kingdom and Assisted Suicide remains illegal, a person assisting will not necessarily be prosecuted. In March 2004 Lord Joel Joffe introduced the assisted dying for the terminally ill bill into the House of Lords. A select committee was established to review the bill. The bill was similar to the Oregon death with dignity act in many ways except for the fact that it allowed a physician to provide a patient with the means to end his or her own life but also allowed the physician to end the life of a patient who was physically unable to do so himself or herself. The bill also required that a patient seeking to end his or her own life must do so in front of a solicitor who finds the patient to be of sound mind and is satisfied that the patient understands the effect of the declaration. The select committee recommended that a clear distinction be drawn between Assisted Suicide and Euthanasia and also that such legislation should make clear what actions a physician may or may not take in assisting suicide or in administering euthanasia. The bill was debated and a subsequent bill was introduced to the House of Lords by Lord Joffe but was defeated. In September 2010 a non-governmental Commission on assisted Dying was set up to assess the issue of assistance in dying. The commission concluded that Assisted Suicide should be legalized in England and Wales, but it outlined recommendations for improved health and social services as well as for eligibility criteria. As a result in May 2016 Lord Falconer presented a new bill to the House of Lords to legalize physician-assisted suicide.[22] While England and Wales have not succeeded in fully legalising the act of Euthanasia and Assisted Suicide the debate has started and efforts have been made to create new and amend existing laws.
Nonetheless, people worry that whatever regulations are put into place they won't stop patients, particularly vulnerable ones, being pressured to choose death when they would rather live.[23] While I acknowledge that this is a very real worry amongst many professionals and the general public, and while many fear that the acts of Euthanasia and Assisted Suicide will be abused we must take a look at the facts before we form an opinion. In Oregon in Two Thousand and Ten, Ninety Seven prescriptions for medication that would aid with ending the life of a terminal ill patient were issued. Sixty five of those Ninety seven prescriptions were distributed and the percentage of Physician Assisted Suicide per 1,000 deaths was 2.09 percentage.[24] In Oregon in Two Thousand and Eleven, One hundred and Four prescriptions for medication that would aid with ending the life of a terminally ill patient were issued. Seventy Two of those One hundred and Four prescriptions were distributed and the percentage of Physician Assisted Suicide per 1,000 deaths was 2.25 percentage.[25] While the number of prescriptions prescribed and deaths due to ingesting such prescriptions has increased slowly almost every year since the law was passed it must be noted that Oregon has a population of almost four million people meaning statistically a relatively low number of prescriptions have been issued to aid terminal ill people with ending their lives when compared to the state’s population[26] and Eighty percentage of those who availed of what the Death with Dignity Act had to offer were suffering from cancer[27]. It must also be noted that the people of Oregon voted in favour of the Death with Dignity Act in November Nineteen Ninety seven with a Sixty percent majority vote.[28] In the Netherlands where the acts of both Euthanasia and Physician Assisted suicide are lawful there was Two thousand Nine Hundred and Ten deaths reported deaths by Euthanasia and One Hundred and Eight reported death by physician assisted suicide in the year of Two Thousand and Ten.[29] In Two Thousand and Eleven, Three Thousand Four hundred and Forty Six deaths were reported deaths by Euthanasia and there was One hundred and Ninety Six reported deaths by Physician Assisted suicide.[30] While the number of people choosing acts of Euthanasia or Physician Assisted suicide are higher in the Netherlands than they are in the state of Oregon we must take into account that the population of the Netherland is over Seventeen million and the Netherlands would experience a larger number of terminal ill people traveling there to avail of the right to end their lives than the state of Oregon would. After analysing the number of people who use methods of Euthanasia and Physician Assisted Suicide to end their live I think we can form an opinion that the right to avail of Euthanasia and Physician Assisted suicide in Countries and States were it is legal is not being abused by the general public and is being reserved for those with patients suffering from an incurable and painful disease.
[...]
[1] Oxford English Dictionary, Oxford University Press
[2] Oxford English Dictionary, Oxford University Press
[3] Fleming v Ireland & ors, [2013] IESC 19
[4] Live interview with Tom Curran (Marie Flemings partner) and Ryan Tubridy https://www.youtube.com/watch?v=jvlCQYpR0jI
[5] Live interview with Tom Curran (Marie Flemings partner) and Ryan Tubridy https://www.youtube.com/watch?v=jvlCQYpR0jI
[6] John Stuart Mills, utilitarianism (second edition)
[7] John Stuart Mills, utilitarianism (second edition)
[8] John Stuart Mills, utilitarianism (second edition)
[9] Julla Nicol, Marllsa Tledemann and Dominique Vallquet “Euthanasia and Assisted Suicide: International Experiences” 2011 Reviewed 2013, pg 2
[10] HSE, “National Clinical Programmes” http://www.hse.ie/eng/about/Who/cspd/ncps/palliative-care/
[11] Deborah Condon “Do not resuscitate – who decides” http://www.irishhealth.com/article.html?id=3475
[12] Brigit Taylor and Robert McCann, M.D “Controlled Sedation to Treat Pain and Severe Physical Symptoms in Terminally Ill Patients Explored in Journal of Palliative Medicine” http://www.liebertpub.com/global/pressrelease/controlled-sedation-to-treat-pain-and-severe-physical-symptoms-in-terminally-ill-patients-explored-in-journal-of-palliative-medicine/384/
[13] John R. Williams, PhD; Frederick Lowy, MD, FRCPC; Douglas M. Sawyer, MD, FRCPC “Canadian physicians and euthanasia: 3. Arguments and beliefs” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1485552/pdf/cmaj00266-0049.pdf
[14] Kant “Hypothetical and Categorical Imperatives” http://moralphilosophy.info/normative-ethics/deontology/kantian-ethics/hypothetical-and-categorical-imperatives/
[15] Kant “Hypothetical and Categorical Imperatives” http://moralphilosophy.info/normative-ethics/deontology/kantian-ethics/hypothetical-and-categorical-imperatives/
[16] Kant “Hypothetical and Categorical Imperatives” http://moralphilosophy.info/normative-ethics/deontology/kantian-ethics/hypothetical-and-categorical-imperatives/
[17] Kant “Hypothetical and Categorical Imperatives” http://moralphilosophy.info/normative-ethics/deontology/kantian-ethics/hypothetical-and-categorical-imperatives/
[18] John Stuart Mills, utilitarianism (second edition)
[19] Julla Nicol, Marllsa Tledemann and Dominique Vallquet “Euthanasia and Assisted Suicide: International Experiences” 2011 Reviewed 2013, pg 4
[20] Julla Nicol, Marllsa Tledemann and Dominique Vallquet “Euthanasia and Assisted Suicide: International Experiences” 2011 Reviewed 2013, pg 4
[21] Julla Nicol, Marllsa Tledemann and Dominique Vallquet “Euthanasia and Assisted Suicide: International Experiences” 2011 Reviewed 2013, pg 11
[22] Julla Nicol, Marllsa Tledemann and Dominique Vallquet “Euthanasia and Assisted Suicide: International Experiences” 2011 Reviewed 2013, pg 9
[23] BBC “regulating Euthanasia” http://www.bbc.co.uk/ethics/euthanasia/overview/regulation_1.shtml
[24] Julla Nicol, Marllsa Tledemann and Dominique Vallquet “Euthanasia and Assisted Suicide: International Experiences” 2011 Reviewed 2013, pg 6
[25] Julla Nicol, Marllsa Tledemann and Dominique Vallquet “Euthanasia and Assisted Suicide: International Experiences” 2011 Reviewed 2013, pg 6
[26] Julla Nicol, Marllsa Tledemann and Dominique Vallquet “Euthanasia and Assisted Suicide: International Experiences” 2011 Reviewed 2013, pg 6
[27] Julla Nicol, Marllsa Tledemann and Dominique Vallquet “Euthanasia and Assisted Suicide: International Experiences” 2011 Reviewed 2013, pg 6
[28] Julla Nicol, Marllsa Tledemann and Dominique Vallquet “Euthanasia and Assisted Suicide: International Experiences” 2011 Reviewed 2013, pg 6
[29] Julla Nicol, Marllsa Tledemann and Dominique Vallquet “Euthanasia and Assisted Suicide: International Experiences” 2011 Reviewed 2013, pg 14
[30] Julla Nicol, Marllsa Tledemann and Dominique Vallquet “Euthanasia and Assisted Suicide: International Experiences” 2011 Reviewed 2013, pg 14