The given essay will touch upon the problem of an ethical issue of euthanasia or assisted suicide. It represents the consideration of the dilemma of euthanasia versus community norms. It also discusses definite moral principles underpinning this dilemma, namely autonomy of the patient’s rights, social justice, beneficence, non-maleficence and paternalism. Moreover, the problem is considered from the point of view of the Code of Ethics and legislature.
Medicine is an absolutely special area of human knowledge as it unites science and values which do not have anything in common with a science. The professional activity of any medical worker, either nurse or physician, is based on beneficence. Its nature is not scientifically proved. Ethics and medical philosophy are based on compassion and awe of human life. Medical activity can be extremely scientific without it and can lose its essence. However, what are the grounds of this moral duty?
The ethical problem with its basic question - the relation between a medical worker and a patient - is not separable from any kind of medical activity. Since the times of Hippocrates, the judgment that the moral culture of a medical worker is not only worth personal characteristics, but also qualities defining professionalism, has been indisputable. Ethical issues are very important for nursing.
Modern medicine and supporting life prolongs sufferings. Euthanasia is presented as a merciful act in relation to a suffering person. The supporters of euthanasia consider it admissible in the conditions if a patient has a right to make a decision independently. In order to emphasize a position of human rights observance, the Canadian literature calls euthanasia PAS - “physician assisted suicide” or “assisted suicide”. Anyway, a doctor’s assistance is necessary: to prepare a cocktail, to disconnect artificial breath, kidneys, etc. Assisted suicide or euthanasia is the only way out for suffering people and not less suffering relatives to ease the patient’s lot (Boyd, 2005).
Euthanasia is a termination of life of a hopelessly sick person feeling intolerable pains under his or her request. The distinction between two types of euthanasia is considered the major problem of medical ethics. There are two types of euthanasia: passive and active. Passive euthanasia is applied when a patient stops any medical procedures and actions; in contrast, active euthanasia is applied when special measures for life termination are undertaken.
The issue of euthanasia has arisen not today, and not all of a sudden. It roots back to the ancient times. Then it evoked numerous disputes among physicians, lawyers, sociologists, psychologists, etc. The attitude to the deliberate acceleration of death approach for incurably sick person, even for the purpose of termination of his sufferings, had never been unambiguous. An English philosopher Francis Bacon (1561-1626) for the definition of easy painless death introduced the term – “euthanasia” (from Greek “euthanasia”, “eu” – “good”, “thanatos”- “death”), which means good, quiet and easy death, without tortures and sufferings.
The opinions about euthanasia are often contradictory. Some believe that a hopelessly sick person has no need to suffer, and, in this case, a fast death can become the only way out for him; others consider that a seriously ill patient should live until there is a possibility to live - till the end of life and the beginning of death.
There is an opinion that an active termination of life is more humane than passive expectation of human forces exhaustion as it stops sufferings of a patient, instead of prolonging of a patient’s artificial life. The dilemma between active and passive euthanasia is the one between killing and allowing dying. Passive euthanasia takes the form of a long painful dying when a patient is refused in soothing treatment or metabolism maintenance. Why is killing wrong, but is it right to allow dying? A boarder between them is not basic. Is this distinction moral or not? In both cases it was intended.
It is more essentially to distinguish voluntary and non-voluntary euthanasia. There are situations when a person cannot express own will (those who are in a steady vegetative condition, in a clod, babies, etc.). Assisted suicide or euthanasia is the only way out for suffering people and not less suffering relatives to ease the patient’s lot. Would anybody among us want to burden children and friends with care for people for whom the only way of relief and tortures deliverance is death?
It depends upon medical ethics. In the USA, for example, physician has the right to tell the patient that he/she is hopeless. From the point of view of any man of faith, the physician becomes the deliberate murderer and it considers as a sin. If to give the chance for the patient to make it so this considers as the worst sin - suicide. What is it more important: a suffering body or a soul? Though, if there is no way out, there is no sin as well. What does a person need to suffer for?
The Patient Self-Determination Act was approved in 1991 in the USA and binds hospitals to inform the patient about the right to die. This right includes possibility to refuse treatment resulting in death. Assisted suicide or euthanasia can be considered as a logical extension of the patient’s right to self-determination.
The overwhelming majority of doctors and lawyers consider euthanasia absolutely inadmissible; moreover, penal even if it is undertaken extremely “in mercy”, under the persevering requirement of the patient who anyway should die shortly. This topic is quite rhetorical and it is necessary to consider such question through the prism of reality, but proceeding from a concrete critical situation.
In the debate of physician-assisted suicide, there are many valid arguments on each side. Whichever path society does choose in regards to physician-assisted suicide, moral objections will need to be addressed. Either way, the public needs to be educated about the different legal options concerning the end-of-life care and the consequences of any changes in laws governing such care (Boyd, 2005).
The dilemma of euthanasia, or assisted suicide, is entirely philosophical, it evokes lengthy debates and shows that medicine, despite outstanding successes, often happens to be powerless to help the patient. Everyone agrees that any illness is the heartrending experience directed at the soul’s clarification. It is clear, that not every suffering person has enough will power to pass this way up to the end. Both patients, their close people and physicians, seeing all the sufferings of the patient, believe humane to interrupt suffering by voluntary (or compulsory) life termination. However, whatever verbal forms were used to name this process, or whatever promptings were accepted, nevertheless, it is called a murder or a suicide with all sequential karmic consequences. A basic question exists: who will be the executor of this process: the murderer or the suicide? Who will incur execution and karmic consequences: the physician or the patient? Physicians used to try all the possible means to alleviate sufferings until the last minute of life (Boyd, 2005).
Difficult bioethical problems cover many sides of modern community development. Therefore, social institute of ethical committees, which represents a multilevel network of public, state and international organizations, were created for their salvation. Ethical committees exist at the research organizations and hospitals, professional associations (medical, nursing, pharmaceutical), state structures, and international organizations (UNESCO, WHO, and the Council of Europe).
The problems of identification, analysis and search for salvations require the application of general ethical principles and norms, based on common values. From the point of view of practice, this process covers the measures on identification of a new set of circumstances, arising in science and technologies, decision-making by managing bodies and educational and informational programs implementation.
The Hippocratic Oath includes all spheres of the physician’s activity in which he should follow the principle of non-malificence: physical (to treat correctly, to choose a method of treatment which will cause the least harmful by-effect not to promote death or abortions), social-psychological and legal (nondisclosure of a medical secret), moral (respect and gratitude to the teachers, colleagues) (Baird, 2009).
Bioethics is based on the representations about insufficiency of one-sided medical interpretation of corporal well-being as medical purposes. An absolute must is interdisciplinary dialogue of physicians with the representatives of a wide range of humanities and dialogue with patients and community representatives. The cultural grounds of bioethics consist of moral understanding of the inseparable bonds with nature and its preservation leading to the moral responsibility. Bioethics also covers the problems of a holistic character, including a wide spectrum of social problems. Therefore, one of the bioethical aims is the development of the criteria and norms allowing or limiting implementation of such experiments on human beings. Such experiments can change the behavior, mentality and, finally, create the possibility to manipulate person (Brody, 2003).
The key rule at communication with people who are bent on euthanasia is a spiritual care. A spiritual care is not a luxury accessible to a few; it is an essential right of each person as well as political freedoms, the right to medical aid, and equality of possibilities. The true democratic ideal should include the qualified spiritual care for each person in a number of the most essential positions (“Code of Ethics for Registered Nurses”, 2008).
Communicating with elderly people, family and medical personnel should follow the principle of non-malificence. It is not contained literally in the Hippocratic Oath, but it became a natural base for the works of doctors and psychologists working in medicine. The obligation “not to cause any harm” became not only the main moral principle of medical activity, but also a moral basis of interaction model of medical workers with the dying patients, their relatives, colleagues and teachers.
Spirituality has become important to holistic assessment in medicine recently. Each person is unique in his spirituality. A strong faith in God can heal by its power. Only a man of faith can conquer all the diseases. The only way to encourage colleagues is to show them vivid examples of spiritual healing.
Even though illness, death, and dying are universal experiences, the ways people understand and respond to them are shaped by the attitudes and beliefs of their particular culture. Broadly speaking, our cultural background provides a road map or lens of perception through which the world is understood and interpreted. Culture impacts the meaning of health, illness, and dying; relationships between patients and health providers; how end-of-life decisions are made; communication styles; and so forth. The challenge for health care providers is to learn how cultural factors influence patients’ health beliefs, behaviors, and responses to medical issues in order to assure high quality care for all (Austerlic, 2009).
The “expected” role to death and dying consists of the spiritual care to the dying relative. Spiritual care can help the dying relative to feel the family support and own significance. It is important to surround a dying relative with care and attention. The most important fact of the spiritual care provision is to help the dying person to live the last weeks or months with the feeling of love of the close people.
Death is an inevitable outcome of every person’s life but each individual’s experience of death is unique. Providing care for a person as they enter the final stages of their life is often stressful and sad for families, a situation that may be worsened when health professionals make assumptions about a patient’s beliefs (Clark, 2010).
In case of a serious, incurable disease of a close relative, the family members and health care personnel provide a dying patient with home health care. There are a lot of reasons for it, but the most important is that the home-based care is more humane and compassionate one if compared with any other form of care. The most important approach to the patient is the fact that each human being consists not only of body, but of spirit, soul and body. Each doctor, facing such problems as incurable illnesses, comes to it in his/her practice. When a competent experienced doctor comes to the understanding of his/her helplessness, he or she has to search for the most humane variants to help the patient to die.
In such cases, home care is used. It includes the services and tools in theplace of house of individuals and families that need such services and tools as a result of severe illness, long term health conditions, lastingphysical deformations and incurable diseases. Home-based care includes the creation of the comfortable atmosphere, favorable psychological climate, and provision of the appropriate spiritual care.
In the medical journal “Annals of Internal Medicine”, there is Code of Ethics for Registered Nurses. According to this code, there are three principles and ten duties for any nurse. The first principle, the priority of patient’s welfare, is known since ancient times. Trust, possibility for the patient to rely on a nurse as a medical worker is the essence of the concept “medical worker - patient”. The second principle is self-determination or autonomous will and personal independence. It is understood from the point of view of a patient’s choice. A person decides his life himself and it is the only a person who can make a choice between health and illness. The last principle is of social justice. It summons the whole medical sphere to be equal and fair when distributing the limited resources of health care (“Code of Ethics for Registered Nurses”, 2008).
The code of ethics for registered nurses sets out the ethical behavior expected of registered nurses in Canada. It gives guidance for decision-making concerning ethical matters, serves as a means for self-evaluation and self-reflection regarding ethical nursing practice and provides a basis for feedback and peer review. The code delineates what registered nurses must know about their ethical responsibilities, informs other health care professionals and members of the public about the ethical commitments of nurses and upholds the responsibilities of being a self-regulating profession. This code serves as an ethical basis from which to advocate for quality practice environments with the potential to impact the delivery of safe, competent and ethical nursing care (Code of Ethics for Registered Nurses, 2008).
Thus, the observance of the principle of non-malificence is very important in euthanasia questions. It requires professional knowledge and experience principles corresponding to bioethics. According to these principles, there is a representation of a nurse or a doctor as a person who knows better what is good and what is bad for the patient.
In a bioethics context, paternalism means action without the consent, or even, on the contrary, to the desires of the patient in order to benefit or, at least, to prevent him from causing harm. There are two elements in this principle: the absence of the consent and merciful motive (well-being of a patient) (“Code of Ethics for Registered Nurses”, 2008).
The conflict between a respect of autonomy and desire to help the patient leads to a paternalism problem. Paternalism occurs when one person prevents the other person from decision-making for the good of this person.
The advocates of euthanasia say about the possibility of choice, the fact that nobody has the right to force hopeless patients to endure cruel tortures, that vegetative existence and a pain deprive the person of dignity; that patients, aspiring to put an end to the sufferings, frequently resort to much more awful ways of suicide, than a painless injection. They declare that if life is not truly human (life in dialogue) it is better to die humanly (with the help of euthanasia). This method justifies active euthanasia (Dyck, 2001).
There are a lot of arguments for euthanasia. The condition of some people is in such a level that it is better for them to die than to continue living. Vivid examples of such situations are those patients who suffer from severe pains or are doomed to life in humiliating dependence on others even in satisfaction of the bare needs. Mortally sick and those, who are in a constant vegetative condition, are included in this category.
The second argument lies in the fact that rendering assistance to someone in improvement of his state of health is always morally admissible. If killing improves someone’s state and the person wants to be deprived of his own life for the sake of his own self, then how similar killing can be considered as causing undeserved harm to the person? How is it possible to consider this deed unfair? How can it be wrong?!
A large number of people who choose Euthanasia are those who suffer from painful diseases that cannot be treated. If they choose not to bear the pain, they should have the right to do so. Some also believe that if a patient wants to end his life out of his own will he should be allowed to, as this also relieves medical resources to be used in cases where the patient could be cured (Bose, 2010).
Arguments of those who consider euthanasia inadmissible are not less serious as well. For example, in their opinion, it is impossible to charge doctors with responsibility for killing of a person. They pay attention to the fact that medicine develops very quickly, and ways of treatment of the illnesses which had been recently considered to be hopeless are found today; thus, disconnecting the patient from life-support systems, we deprive him of his chance to wait for the invention of a medicine for his illness.
However, the main and really not solved ethical problem rises concerning patients who are not able to make the decision on ceasing to live independently: being in a coma, mentally impaired, including senile imbecility, and also absolutely small children. If euthanasia is legalized, who will make decision for them: doctors, relatives or authorities? Besides, what are the guarantees, that their decision will be dictated by the reasons of humanism and interests of a patient? After all fascist programs of “nation’s improvement” by mass destruction of feeble-minded, mentally sick, invalids, homosexuals, etc. has not been erased from the historical memory yet.
The intended killing of the innocent is always a moral harm. The church completely condemns euthanasia. Condemnation concerns any encroachment on human life - as abortion and euthanasia.
Euthanasia does violence to this natural goal of survival. It is literally acting against nature because all the processes of nature are bent towards the end of bodily survival. Euthanasia defeats these subtle mechanisms in a way that, in a particular case, disease and injury might not (Baird, 2009).
The main arguments against euthanasia are:
1. Euthanasia is killing of a human being, and killing itself is a sin and is always condemned;
2. Euthanasia can lead to its abuse, which can result in euthanizing of all “unnecessary” people against their wills;
3. Euthanasia rules out the possibility of potential recovery for the patient. It remains the only way out – death;
4. Euthanasia may not always be chosen voluntarily. Quite the contrary it may be chosen under the influence of more interested people.
To sum up, it is difficult to say what side is right. Everything above-said about lawful and illegal is absolutely correct, but insufficient in a modern dispute about euthanasia. The true answer to the ethical dilemma of euthanasia can be the aid for a dying patient and support him/her during the last moments of life. It is the human answer which makes any objections to be silent, of course, if there is no intention to deride love, patience, professionalism of those who devoted themselves to this service to the dying people, or, more precisely, to support alive on his way to death: “to accompany life to the death”.
The dilemma of euthanasia is quite rhetorical and it is necessary to consider such a question through the prism of reality, but proceeding from a definite critical situation. The Lord does not give us more sufferings than we can endure. People’s mission on the Earth is to suffer in tortures. Having stepped over the forbidden line, there is no way back. The servants of the God were born to pass severe ordeals and pangs. It is not a human being who gave life to himself, and it is not a human being who can be the master of his own destiny. There is only one reason which allows to lose one’s life voluntarily - to save the life of the other person. All the other reasons are named with the only word - crime. The crime against humanity, against one’s own self, against the Lord.
In my personal opinion, the most reasonable position is: euthanasia has a right to exist. It is much more human to save person and surrounding people, relatives and friends from such tortures. On the other hand, I think that euthanasia is a suicide. It is not my business whom to blame. However, we should remember one simple thing: the God did not give us more sufferings than we can endure. Still, I believe that it is better to pass away and not to suffer any longer, if you are just a vegetable.
Euthanasia is a concept, it seems to me, that is in direct conflict with a religious and ethical tradition in which the human race is presented with “a blessing and a curse, life and death”, I believe “euthanasia” lies outside the commonly held life-centered values of the West and cannot be allowed without incurring great social and personal tragedy (Koop, 1991).
Our society lives in fear in front of death, but after all death of a physical body is one of the immutable components of circulation of natural powers. The death is one of the forms of life continuation. In east religions, for example, Buddhism interprets death as the phase transition of conditions of a human spirit and soul, as well as animal world and flora. There is a plate on a gravestone of one of the most outstanding people of our times Osho. It reads: “Never was born, never died”.