Euthanasia: Why do people disagree about the ethics of euthanasia?

When is it okay for a doctor to stop trying to save their patient and start helping their patient die? In this Wi-Phi video, we’ll explore some important questions that shape the debate over euthanasia. Several months ago, Jack was diagnosed with cancer. Despite multiple rounds of treatment, the cancer has advanced quickly, and his doctors now think he has only a few weeks to live. The treatment isn’t working, Jack’s oncologist, Tina, explained. It’s time to focus on making his remaining weeks as comfortable as possible. Jack has thought about it and doesn’t want this painful, miserable time to drag out. He’s lived a long and mostly happy life, and now just wants to die a quick and easy death. Explaining this to Tina, he asks her to end his life with an injection of lethal drugs. Should Tina be allowed to follow through on Jack’s request to help him die a “good death”? Or should such acts of euthanasia be prohibited? A good starting point for thinking through what a provider should be allowed to do in euthanasia scenarios like this is to ask: Would euthanasia be best for the patient’s overall well-being? After all, the main reason a patient like Jack seeks an expedited death is his belief that he’s better off dead than living a few more weeks under such terrible circumstances. This also explains why he thinks Tina should help him. As a healthcare provider, Tina’s role isn’t just to heal her patients and save their lives it’s to care for their physical and mental well-being <i>overall</i>. Indeed, Tina has already shifted from trying to save Jack to just trying to manage his suffering until he dies. Since even that’s not working, it’s worth considering whether euthanasia might be the most effective and compassionate way for Tina to care for Jack’s well-being. So is it? Some people believe life is such a precious gift that no matter how bad things get, it’s always better to be alive than not. Others think the value of being alive has its limits: sometimes the conditions of life are so bad, that the benefits of being alive don’t really help. Even opponents of euthanasia might agree that the bad things that lie ahead for Jack probably outweigh the good. Of course, this accounting depends on what qualifies as good and bad, and their relative weights. And this is often confusing and subjective. For example, one reason we might see little good left for Jack, relative to the bad, is that he has no hope of recovery and just weeks left to live. But what if he had months left? Or a year? Would Jack then be wrong if he still thinks an expedited death is best? More time to live means more time for experiences and activities that improve his well-being. Then again, it also means more time for suffering and profound dependence on others. Maybe the value of living counterintuitively goes <i>down</i> the more time he has left. Also, how much does the <i>kind</i> of suffering matter? Is Jack’s well-being compromised more by his physical pain and discomfort? Or by his fear, humiliation, and despair? What if Tina could greatly reduce his suffering with medications, but they left him too unconscious to engage with the world around him? Would this be better than a quick death? Wait! you might say. Why are <i>we</i> deciding what’s best for Jack? Everyone has different values and beliefs, and surely no one knows better than Jack whether living out his remaining weeks is worth it. Even if he’s wrong, it’s his life! Jack’s doctors have to respect his autonomy regarding all his other healthcare decisions: why shouldn’t he also get to decide for himself how his life ends? To many, the crucial question is simply: Would the patient be an autonomous participant in their euthanasia? If the answer is no, the act should be prohibited; if the answer is yes, it should be allowed. Now, obviously Jack has explicitly requested euthanasia. But not every request from a patient is genuinely autonomous. A patient might be so overwhelmed by pain or fear, for example, that they can’t adequately comprehend their situation and make a competent decision. Or they might be coerced by doctors or family members concerned about the costs of continuing care. Some people are skeptical that <i>any</i> euthanasia request is truly autonomous, given the suffering and vulnerability that motivated the request. But most think that, as long as the doctor takes proper precautions to ensure the request is competent and voluntary, they can carry it out. And given the details of Jack’s case, it seems plausible both that euthanasia is in his best interest and that his request is autonomous. And yet, in most places, Tina would lose her license and be charged with murder for fulfiling his request! Why? Well, we haven’t yet asked perhaps the most controversial question: Is the proposed method for carrying out this euthanasia ethically permissible? In asking Tina to hasten his death by injecting him with lethal drugs, Jack is asking Tina to <i>intentionally kill</i> him. And many believe that intentionally killing someone is absolutely wrong, regardless of the net good that might result. Every person, they say, has an inherent moral dignity, or value, that must never be violated. On the other hand, many of the same people would probably let Tina take a willing patient off their ventilator, knowing the patient will therefore die from insufficient oxygen. Why? Because here Tina would merely be <i>letting the patient die</i>. Others aren’t convinced that the distinction between killing and letting die really matters. They claim that helping Jack die with dignity means letting him decide both when and <i>how</i> to die. The final question to consider is sometimes raised even by people who think euthanasia can be justified in this or that individual case. What still concerns them is this: Would a rule that allows euthanasia in cases “like this” have undesirable social consequences? They worry that allowing euthanasia in certain limited, acceptable cases will gradually encourage expansion of these limits until it’s allowed for even <i>unacceptable</i> cases. They particularly worry that allowing euthanasia for patients considered “especially unfortunate” might send the message that everyone facing similar conditions has a life that isn’t worth living. To properly assess whether Tina should be allowed to fulfill Jack’s request, they say we must not only determine whether euthanasia is in Jack’s best interest, whether he’s participating autonomously, and whether the requested method is acceptable we must also consider the wider social context and whether strong regulations can be established to prevent society from sliding down vicious slippery slopes. What do you think?