Jack Kevorkian served 8 years in prison for second-degree murder, that is murder that is not “premeditated”, or what you may also describe as murder that is not ill-intentioned. Essentially, he was a doctor that assisted many ill patients to die; what we commonly call euthanasia. He argued that he was imprisoned for being merciful, and that his merciful acts were to procure or hasten the death of other human beings. They were merciful because he aimed through his actions to liberate the person from suffering due to illness – when this person had indicated that they wanted or needed his assistance to do just this. The law said that regardless of the intent, procuring or hastening someone’s the death equates to murder and this is illegal even if the other party consents and requests it.
Now, a lot of the issues surrounding euthanasia and death legislation are about semantics, and to a lesser degree also intent. I remember first learning about euthanasia in a bioethics class, and I will describe it briefly now as I was taught it. There were four categories of “euthanasia” described:
1) voluntary active euthanasia (where the patient voluntarily requested help in dying and another person actively helped him achieve this) – E.g. a person asking someone else to inject a fatal substance into them.
2) voluntary inactive euthanasia (where the patient voluntarily requests help in dying and another person acts by withdrawing or ceasing an action that is helping the patient stay alive), - E.g. a person asking someone else to pull out all tubes providing life-saving support like oxygen or fluids, etc.
3) non-voluntary active euthanasia (where the patient does not actually request or oppose help in dying and he is acted upon so as to hasten his death), - E.g. a non-communicative or possibly brain-dead patient who has made no prior indication of his wishes in this situation being given a fatal substance to hasten their death.
and 4) non-voluntary inactive euthanasia (where the patient does not request or oppose help in dying but another person acts by withdrawing or ceasing an action that is helping the patient stay alive). - E.g. a non-communicative or possibly brain-dead patient who has made no prior indication of his wishes in this situation having all life-supporting measures like oxygen or fluids withdrawn.
“Non-voluntary” is used as opposed to “involuntary” because involuntary implies that it is against the person’s wishes whereas non-voluntary simply that it is not opposed nor is it specifically desired. For example, involuntary active euthanasia could be thought of as common first-degree murder where a person does not want to die but he is purposely killed. Involuntary inactive euthanasia could be akin to a person actively asking for my help to avoid death (which I can presumably prevent by some action) but I withhold from providing this life-saving thing. This is a crime similar to murder in many countries too.
In most countries in the world what the law forbids are active forms of euthanasia, and in fact inactive forms of euthanasia are quite readily accepted – and legal. Every day in intensive care units patients are non-voluntarily actively euthanized, when their treatment is deemed futile by someone other than the patient themselves. And our right to “voluntary inactive euthanasia” is hailed one of the great achievements in medical ethics when doctors were disrobed of the expectation of paternalism to have that same power handed back to the alert, competent patient, in the form of autonomy. Any patient in the world can refuse any treatment in the world even if that treatment is considered life-saving. You can even write down your wishes when you’re still able to communicate them for future reference, for those times when you are non-communicative or no longer medically-competent. But I am digressing here, I could go on for hours on medical ethics, but what I really wanted to discuss is active forms of euthanasia.
Take religion and law away from the argument for a moment and try to discuss why euthanasia is “wrong”. Well, they tell us, it’s inherently bad because it has the potential for abuse and you run the risk of evil people wanting to just kill whoever for whatever trivial reason. Reasons such as, maybe, “he’s no good to society anyway”, “I don’t like him”, “he is of this race or culture”, “he’s poor”, or “he has no family”, or “he will cost more than I am willing to spend to keep alive”, etc. etc. There are many things in medicine with potential for abuse. We often hospitalize and treat the mentally ill; we force-feed those with eating disorders; we prescribe medications with known side-effects; we terminate the lives of foetuses for whom we can’t prove either way whether they are “persons” with an independent right to life or not, etc. I even heard it once said that one of the biggest mistakes in medicine was the idea to try to keep premature babies alive at all costs. Many of these babies will have chronic health problems, and the expenditure on neonatal intensive care units is massive. Some would say we have abused the technology in life-sustaining measures by trying to apply it to each and every patient, even these tiny babies which we are potentially setting up for terrible lives. My point isn’t to argue if these tiny babies are worth it or not worth it; my point is that we do entrust health professionals with many life and death situations all the time. And we do this because we have assumed they won’t abuse their powers just to see a new technology or treatment work without thinking of the consequences.
So then, why else is euthanasia “wrong”? They say because we could make a mistake – and the consequences of that mistake is not reversible. Again, doctors face this potential every day! I think that if you were to filter it down, the real controversies with euthanasia are 1) religion, 2) law, and 3) an expectation (or perhaps misconception?) that the overriding aim of medicine is to prolong an individual’s lifespan (as opposed to other aims like preserving their dignity, ensuring quality of life, and having a social responsibility to the rest of our fellow humans). Unfortunately, like many things in life, when you use one rule to apply to everyone in every situation, you will often get it wrong. Many people do not like to think that their doctor could have the knowledge or ability to perform euthanasia, because they assume doctors are special and, like I mentioned, should only want to prolong a person’s life. However, I believe that keeping euthanasia from the scope of medicine isn’t keeping us from any evil we aren’t already at risk of committing. I also don’t support allowing the scope of euthanasia to evolve without the input of medical professionals. If you’re going to do something, do it right. This is called harm minimization, and is not a new concept to medicine at all.
But why do I personally believe that euthanasia isn’t bad (if it were able to delivered effectively and without inflicting further harm or pain)? Because I believe that every person is free and free to choose to live their life how they choose. I also think it is cruel to deny someone something, especially their freedom of choice, simply because they need someone else’s assistance to achieve their goal. Imagine being denied access to the top floor of a building because you are a paraplegic in a wheelchair and the building isn’t equipped with elevators or ramps. Now, imagine that the reason you want to get to the top floor is because on the ground level where you are there is a fire that keeps intensifying. Don’t you wish someone could help you? But no-one can because then they will be arrested and they would rather not go to prison, even if they’re your friend or relative and they love you. So you’re left to fend for yourself. No-one bans you from going to the top floor, it’s simply a shame you can’t get yourself up there – and that is your only option! Oh well, better just wait for the fire to intensify, your skin to burn, and to watch yourself helplessly, and probably painfully, die. You knew all along that upon going to the top floor you’d only fall asleep and die up there, but hey, wouldn’t it have been nicer? Apparently not. Apparently it is nicer to allow our much-esteemed friends and family members to die in pain and helplessness.
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