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Euthanasia: A Question Of Ethics Essay, Research Paper

Euthanasia: A Question of Ethics

Euthanasia is one of the most acute and uncomfortable contemporary

problems in medical ethics. Is Euthanasia Ethical? The case for euthanasia

rests on one main fundamental moral principle: mercy.

It is not a new issue; euthanasia has been discussed-and practised-in

both Eastern and Western cultures from the earliest historical times to the

present. But because of medicine’s new technological capacities to extend life,

the problem is much more pressing than it has in the past, and both the

discussion and practice of euthanasia are more widespread.

Euthanasia is a way of granting mercy-both by direct killing and by

letting the person die. This principle of mercy establishes two component

duties: 1. the duty not to cause further pain or suffering; and 2. the duty to

act to end pain or suffering already occurring. Under the first of these, for a

physician or other caregiver to extend mercy to a suffering patient may mean to

refrain from procedures that cause further suffering-provided, of course, that

the treatment offers the patient no overriding benefits. The physician must

refrain from ordering painful tests, therapies, or surgical procedures when they

cannot alleviate suffering or contribute to a patient’s improvement or cure.

Perhaps the most familiar contemporary medical example is the treatment of burn

victims when survival is unprecedented; if with the treatments or without them

the chances of the patient’s survival is nil, mercy requires the physician not

to impose the debridement treatments , which are excruciatingly painful, when

they can provide the patient no benefit at all. Although the demands of mercy

in burn contexts have become fairly well recognized in recent years, other

practises that the principles of mercy would rule out remain common. For

instance, repeated cardiac resuscitation is sometimes performed even though a

patient’s survival is highly unlikely; although patients in arrest are

unconscious at the time of resuscitation, it can be a brutal procedure, and if

the patient regains consciousness, its aftermath can involve considerable pain.

Patients are sometimes subjected to continued unproductive, painful treatment to

complete a research protocol, to train student physician, to protect the

physician or hospital from legal action, or to appease the emotional needs of

family members; although in some specific cases such practises may be justified

on other grounds, in general they are prohibited by the principle of mercy.

Weather a painful test or therapy will actually contribute to some overriding

benefits for him or her, they should not be done.

In many such cases, the patient will die whether or not the treatments

are performed. In some cases, however, the principle of mercy may also demand

withholding treatment that could extend the patient’s life if the treatment is

itself painful or discomforting and there is very little or no possibility that

it will provide life that is pain-free or offers the possibility of other

important goods. For instance, to provide respiratory support for patient in

the final, irreversible stages of a deteriorative disease may extend his life

but will mean permeant dependence and incapacitation; though some patients may

take continuing existence to make possible other important goods, for some

patients continued treatment means pointless imposition of continuous pain.

The principle of mercy may also demand letting die in a still stronger

sense. Under its second component, the principle asserts a duty to act to end

suffering that is already occurring. Medicine already honours this duty through

its various techniques of pain management, including physiological means like

narcotics, nerve blocks, acupuncture, and neurosurgery. In some cases pain or

suffering is severe but cannot be effectively controlled, at least as long as

the patient remains sentient at all. Classical examples include tumours of the

throat, tumours of the brain or bone, and so on. Severe nausea, vomiting, and

exhaustion may increase the patient’s misery. In these cases, continuing life-

or at least continuing consciousness- may mean continuing pain. Mercy’s demand

for euthanasia takes place here: mercy demands that the pain, even if with it

the life, be brought to an end.

Ending the pain, though with it the life, may be accomplished through

what is usually called “passive euthanasia”, withholding or withdrawing

treatment that could prolong life. In the most indirect of these cases, the

patient is simply not given treatment that might extend his or her life. For

example, radiation therapy in advanced cancer. In the more direct cases, life-

saving treatment is deliberately withheld in the face of an immediate, lethal

threat-for instance, antibiotics are withheld from cancer patient when an

overwhelming infection develops, since through either the cancer or the

infection will kill the patient, the infection will kill them sooner and in a

much gentler way. In all of the passive euthanasia cases, the patient’s life

could be extended;it is mercy that demands that he or she be allowed to die.

The second component of the mercy principle may also demand the easing

of pain by means more direct than mere allowing to die; it may require killing.

This usually is called “active euthanasia. In passive euthanasia, treatment is

withheld that could support failing bodily functions, either in warding off

external threats or in performing its own processes; active euthanasia, in

contrast, involves the direct interruption of ongoing bodily processes that

otherwise would have been able to sustain life. However, although it may be

possible to draw a conceptual distinction between passive and active euthanasia,

this provides no warrant for the ubiquitous view that killing is morally worse

than letting die. Nor does it support the view that withdrawing treatment is

worse than withholding it. If the patient’s condition is so tragic that

continuing life brings only pain, and there is no other way to relieve the pain

than by death, then the more merciful act is not one that merely removes support

for bodily processes and waits for eventual death to ensue; rather. it is one

that brings the pain- and the patient’s life- to an end now. If there are also

grounds on which it is merciful not to prolong life, then there are grounds on

which it is merciful to terminate it at once. The easy overdose, the lethal

injection, are what mercy demands when no other means will bring relief.

Pain is a thing of the medical past, and euthanasia is no longer

necessary, though it may have been, to relieve pain. Given modern medical

technology and recent remarkable advances in pain management, the sufferings of

the morally wounded and dying can be relieved by less dramatic means. For

instance, many once-feared, painful diseases-tetanus, rabies, leprosy,

tuberculosis-are now preventable or treatable. Improvements in battlefield

first aid and transport of the wounded have been so great that the military coup

de grace is now officially obsolete. We no longer speak of “moral agony” and

“death throes” as the probable last scenes of life. Particularly impressive are

the huge advances under the hospice program in the amelioration of both the

physical and emotional pain of terminal illness, and our culturewide fears of

pain in terminal cancer are no longer justified: cancer pain, when it occurs,

can now be controlled in virtually all cases. We can now end the pain without

also ending the life.

It is flatly incorrect to say that all pain, including pain in terminal

illness, is or can be controlled. Some people still die in unspeakable agony.

With superlative care, many kinds of pain can indeed be reduced in many patients,

and adequate control of pain in terminal illness is often quite easy to achieve.

Nevertheless, complete, universal, fully reliable pain control is a myth. Pain

is not yet a “thing of the past”, nor are many associated kinds of physical

distress. Some kinds of conditions, such as difficulty in swallowing, are still

difficult to relieve without introducing other discomforting limitations. Some

kinds of pain are resistant to medication, as in elevated intracranial pressure

or bone metatases and fractures. For some patients, narcotic drugs are

dysphoric. Pain and distress may be increased by nausea, vomiting, itching,

constipation, dry mouth, abscesses and decubitus ulcers that do not heal,

weakness, breathing difficulties, and offensive smells. Severe respiratory

insufficiency may mean an agonizing final few hours. Even a patient receiving

the most advanced and sympathetic medical attention may still experience

episodes of pain, perhaps altering with consciousness, as his or her condition

deteriorates and the physician attempts to adjust schedules and dosages of pain

medication. Many dying patients, including half of all terminal cancer patients,

have little to no pain, but there are still cases in which pain management is

difficult. Finally, there are cases in which pain control is theoretically

possible but for various reasons does not occur. Some deaths take place in

remote locations where there are no pain-relieving resources. Some patients are

unable to communicate the nature or extent of their pain. And some institutions

and institutional personnel who have the capacity to control pain do not do so,

whether from inattention, malevence, fears of addiction, or divergent priorities

in resources.

In all of these cases, of course, the patient can be sedated into

unconsciousness; this does indeed end the pain. But in respect of the patient’s

experience, this is tantamount to causing death: the patient has no further

conscious experience and thus can achieve no goods, experience no significant

communication, satisfy no goals. Furthermore, adequate sedation, by depressing

respiratory function, may hasten death. Though it is always technically

possible to achieve relief from pain, at least when the appropriate resources

are available, the price may be functionally and practically equivalent, at

least from the patient’s point of view, to death. And this, of course, is just

what the issue of euthanasia is about.


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