Is Active Euthanasia Ever Justified?

AUTHOR: Norm Edwards

Whilst the issue of active euthanasia (or assisted suicide) raises a number of arguments, for and against, the dilemma faced by doctors, parents, the individuals themselves and lawmakers is, should active euthanasia be allowed or ever justified? To answer this, justification of good cause requires analysis in terms of the pro's and con's as well as the role that moral consideration plays in terms of how we value life, and to what extent we place emphasis on that value and at what point do we say that suffering is good for life. The notion that prolonged suffering is not good for the value of life is assumed here, as is the propensity to save life without causing further distress and pain. Given that several philosophers have offered differing points of view regarding the justification of active euthanasia, it will be argued here that active euthanasia is justified. Particular focus will be on the suffering, autonomous and rescue arguments along with responses to the killing and slippery slope arguments.

Active euthanasia occurs when premeditated action(s) take place to terminate the life of an individual; conversely, passive euthanasia is the withholding of medical treatment that is required to ensure that an individual continues to live, therefore by default, they die. James Rachels makes a point of arguing that if we are to euthanize individuals it should be the active mode as opposed to the passive mode. The American Medical Association (AMA) clearly states that mercy killing is against the modus operandi for doctors, however, where "biological death is imminent" (Rachels, p.249) passive euthanasia is permissible (and, also if the patient or family so chose to elect it). The suffering argument states that if medical treatment is withheld so that eventually the patient will die the result during the interim period is that the patient may unduly suffer extreme pain or agony. This therefore is not humane and would appear to contradict the Hippocratic Oath that doctors are bound to. Thus, passive euthanasia, according to Rachels, allows the patient to die, in agony, yet if a lethal dose was to be administered, the patient will still die, but will not endure periods of agony leading up to that death. Therefore active euthanasia is the more humane approach to take.

There is no difference between active and passive euthanasia in terms of the final result, yet in the process, passive is more painful than active. This is the crux of Rachels' suffering argument. If we are to accept that the option of passive euthanasia is permissible by the AMA, then why is active euthanasia not permissible? In my view it's because the term "killing" as opposed to "letting die" raises moral questions or connotations. However, this terminology, in essence, appears to be an excuse for not allowing active euthanasia. For example, with the throat cancer patient example used by Rachels (p.249) Ð'- death is imminent for this individual and even if treatment was to continue, the patient would die eventually. Death is foreseeable in this case and if passive euthanasia is used to cause the death, then the intent for death to occur was present. By taking the active euthanasia option, the patient is still being allowed to die but more importantly will not suffer any more pain. Again, the death is foreseeable with active euthanasia and of course the intent for death to occur was present, thus, there is no difference between active and passive euthanasia in this case. It's absurd to think that doctors enjoy watching patients in pain for which there is no alleviation and I believe that active euthanasia does not compromise the Hippocratic Oath. The suffering argument espoused by Rachels is a sensible, humane one which should allow the emotion of the term "killing" not to affect what in the end is the best course of action for the individual concerned and at their consent.

The killing argument opposes Rachels approach by professing that killing an individual, in terms of morality, is wrong if we are to accept active euthanasia. As already discussed, the term "killing" appears to be worse than "letting die" in the moral sense. However at what point does the morality of killing not exceed the allowing of insufferable pain and agony that a patient must endure, even though it is probably already known, as in the throat cancer patient example, that the patient will die anyway. Moral consideration, I believe, is what society deems to be acceptable and what is not. I would argue that if society wants to accept that active euthanasia is morally wrong, then they must also accept that in doing so they are supporting the notion of unwanted pain and suffering to those that are experiencing that pain and by doing so are at best contradicting what they term as being morally correct. It is ridiculous to accept that society would allow pain and suffering; therefore, the term "letting die" should be equally applied to active euthanasia as it is to passive euthanasia. The AMA does allow passive euthanasia, as already explained, but again, at what point should the moral view of the termination of life disregard pain and agony? In my view, any causing death argument is flawed in terms of who is responsible for the death. With active euthanasia a doctor actively takes action to cause death; but wait, passive euthanasia effectively does the same because the doctor is still taking action, albeit passive, by not administering medicine, therefore, the causing death argument does not convince.

Turning to Bonnie Steinbock's argument, she thinks that the AMA view on euthanasia does not advocate any difference between active and passive euthanasia, and therefore she disagrees with Rachels' point of view. One of her arguments centres on extraordinary treatment and that this action is not passive euthanasia. Extraordinary versus ordinary treatment is situational dependant. An example of this used by Steinbock is where the use of a respirator to get a patient through a difficult period with respiratory problems (and where death won't result) is ordinary, whereas using a respirator to keep a patient alive whilst in a coma is extraordinary treatment. Her view explains that if extraordinary treatment is withheld from a patient (and at the patient's request) then the AMA allows this, however if ordinary treatment was withheld and death is not imminent, then that is not permissible and indeed it would be considered as medical neglect. Steinbock further considers that although an individual may have the right to refuse treatment, this does not give the right to die. But, if the refusal of extraordinary treatment is caused because of suffering agony