Research Paper on Euthanasia

📌Category: Euthanasia, Health
📌Words: 1427
📌Pages: 6
📌Published: 19 April 2022

One of the most common debates in the realm of biomedical ethics is that of the moral dilemma between active and passive euthanasia. In simple terms, active euthanasia is the intentional killing of a human, be it from injection or another form of lethal means. Passive euthanasia, on the other hand, is the intentional act of letting a person die, which is usually practiced when a patient is withheld or withdrawn from a life-sustaining treatment. Many in the medical sphere, both philosophical and practical, firmly believe that it is morally permissible to use passive euthanasia in cases in which it is absolutely certain that it is in a patient’s best interest for them to be passively withdrawn. However, these same individuals refuse to allow active euthanasia as an ethically acceptable avenue for a patient’s death. In this essay, I will be putting forth Rachels’ four arguments against the mainstream ideology that only passive euthanasia, and not active euthanasia, should be used by physicians.  Moreover, I will critically analyze Rachels’ fourth claim that the most common argument against the doctrine is invalid.

The first argument proposed by Rachels against the use of only passive euthanasia instead of active euthanasia follows that active euthanasia offers a more humane approach to death than passive euthanasia. While active euthanasia is shunned and looked down upon in most medical institutions around the world, Rachels argues that physicians ought to look at active euthanasia in a different light. Essentially, he believes that it is important to consider different cases in which patients were denied active euthanasia and died from passive euthanasia. The conclusion brought from these cases, he insists, is that “the process of being allowed to die can be relatively slow and painful, whereas being given a lethal injection is relatively quick and painless” (Rachels). Essentially, Rachels puts forth the idea that, in certain cases, active euthanasia is the least painful, the quickest, and most effective manner of death for a terminally ill patient.

On a different matter, there are many instances when patients not only suffer from a life-threatening condition, but also have other issues that could affect the decision of medical care. In his second argument, Rachels explains that “the conventional doctrine leads to decisions concerning life and death made on irrelevant grounds” (Rachels). In a well-illustrative example for his argument, Rachels considers infants born with Down’s Syndrome who suffer from an intestinal obstruction and are not operated on. He mentions that, while the surgery for the removal of an intestinal obstruction is relatively simple, the reason for not operating, and essentially, letting the child die, is not because of the operation but because the child has Down’s Syndrome. In other words, Rachels claims that the decisions made concerning life and death are made on irrelevant grounds, such as the decision to let an infant die simply because he or she has Down’s Syndrome.

Intrinsically, most human beings think of killing an individual as morally worse than letting them die. Interestingly, the consesus also reaches the medical field because the distinction between letting die and killing is yet another aspect of euthanasia which is highly disputed. In contrast, Rachels goes against this instinctive belief by arguing that that the doctrine rests on a distinction between killing and letting die that itself has no moral importance. In essence, Rachels challenges the view that it is more acceptable to let a person die than to kill a person through medically lethal means. In doing so, he points out that, in both settings, the outcome  and the intent is identical, that is the patient's death and the deliberate desire for his passing. With this in mind, Rachels argues that even though both acts are very different, the moral implications should be considered the same. To explain this illustratively, Rachels proposes a hypothetical scenario in which two individuals are responsible for a child’s death for reasons of personal gain. In this first scenario, the first person physically kills the child by drowning him in its bath. And in the second, the individual watches the child hit his head, fall unconscious underwater, and drown in his bath as well. The difference between these two cases is that in the first scenario, the person is actively responsible for the child’s death by killing him, whereas in the second, the person is passively watching the children drown to death, or in other words, letting him die. Given this situation, Rachels explains that both persons acted in self-interest and had the same intent in mind, that is the child’s death. So, how could it be justifiable to say that one is more immoral than the other?

The final comments that Rachels disputes comes in the refutation of the most common argument in favor of the doctrine that passive euthanasia is morally acceptable but active euthanasia is not. Essentially, this argument in favor of the doctrine shines light on the actions a physician takes when depicting the two different types of euthanasia. Moreover, to explain this claim, the argument points out that physicians who use active euthanasia as a form of treatment for a terminally ill treatment are responsible for their death, whereas in using passive euthanasia, this argument asserts, the cause of death is of the illness and not of the physician. In more blunt terms, this argument points out that “the doctor does not do anything to bring about the patient’s death” (Rachels). Because this argument is vague, Rachels instantly repudiates this by insisting that it is incorrect to deny culpability of a physician during passive euthanasia because they are passively involved in the procedure of a dying patient.

Given this last argument, multiple things may be pointed out to critically engage with Rachels’ argument. As mentioned above, Rachels sees physicians just as responsible for the death of a patient, whether it is passive or active euthanasia. Objectively, it is important to keep in mind that, indeed, physicians have a liability to that of their dying patients. Consequently, their duty is to that of the patient’s needs and welfare. In letting the patient die by withdrawing life sustaining treatment, the physician’s duty at this point is to end the patient’s life because of terminal suffering that would end up aggravating into unbelievable misery if not withdrawn. However, physician’s also have a duty to uphold fundamental principles beheld by the Hippocratic Oath. One of these principles, “first, do no harm,” forbids physicians to act in a way that would harm their patients. It is argued that, because passive euthanasia provides a passive outcome to death, physicians are able to deter this principle because they do not actively harm a patient. To tie this back to Rachels’ view of physician responsibility with respect to passive and active euthanasia, it would stand to reason that physicians are not only responsible for the care of a patient but are also responsible in upholding ethical dilemmas and established principles. Given this reason, it can be correct to say that, because physicians have a duty to both responsibilities, active euthanasia would prove to disregard the duty to uphold the Hipprocratic ethical standards. In essence, discounting such a duty would place more emphasis on the responsibility of the care for the patient, hence making the physician more responsible for the patient’s death. As for passive euthanasia, physicians make use of both duties by passively relieving a patient and abiding to ethical standards that are presented to them. In saying this, physicians that opt for passive euthanasia over active euthanasia might be considered less responsible for a patient’s death because of their diversion of responsibilities, which obligates them to focus on two issues at once. 

Having established a critique of Rachels’ fourth argument, I should concede that abiding to principles such as “first, do no harm,” should be applicable in most cases, but may be viewed from a different perspective in others. In essence, I believe that the ultimate duty for a physician should be to the patient, not to a principle. Further, I would argue that in many cases it may be considered perfectly acceptable to accommodate “first, do no harm” with respect to active euthanasia. Many dispute this because this would imply killing a patient, and in essence, harm them. However, I disagree and view active euthanasia as another form of beneficence. In relieving great distress in the shortest amount of time, I believe that this can be considered to reduce and eradicate harm caused by the illness that the patient suffers, and not produce harm. With this logic in mind, a physician would bear the same responsibility for killing or letting their patient die because the intent is that of the same: eliminating harm for the patient.

To conclude, euthanasia remains to be a highly debated topic in medicine. Moreover, there proves to be very good arguments on both sides that depict accurately and with reason why euthanasia should or should not be considered. Regardless of the past and on-going debates on the matter, active euthanasia remains outlawed in most countries, which includes most states in the United States. Given this current situation, it is difficult to assess how this debate will evolve and in what substance other arguments may be created. But one thing remains for certain, deliberations involving euthanasia are not going anywhere in the near distant future.

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