The Ethics of Euthanasia and Physician-Assisted Suicide Essay Example

Introduction

This paper makes the argument that euthanasia and physician-assisted suicide should be permitted because their pros based on ideas from ethical theories of utilitarianism and deontology supersede their cons. Physician-assisted suicide and euthanasia are two of the most controversial and often debated bioethical issues, particularly within the healthcare system. They are similar in that both are forms of assisted death and have the same goal of causing the death of a person (Boudreau & Somerville, 2014). However, there is a crucial difference between these two concepts. It is that while physician-assisted suicide involves a licensed doctor availing the lethal means for ending life to a patient so that the patient can use it at a time of their own choosing, euthanasia is a practice whereby the physician actively carries out the request of a patient to assist them to end their life by intravenously delivering the lethal dose of substance to the patient's body (Boudreau & Somerville, 2014).

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Thus, in physician-assisted death as opposed to euthanasia, it is the patient who has the ultimate decision of whether or not to administer the lethal medication to end their life. Each of these ways of ending one's life has its own advantages or benefits and limitations depending on the ethical angle from which one looks at them. One of the most common arguments that is often advanced to justify these biosocial issues is that they enable people to choose when or how to die and hence save them from unnecessary and prolonged suffering which affects their dignity. Thus, many people in the medical profession consider assisted suicide and euthanasia as the most humane and dignified means of ending a person's life.

The Deontological Perspectives of Physician-Assisted Suicide and Euthanasia

Immanuel Kant, an 18th-century German philosopher, came up with the deontological or duty-based ethics in which he argued that ethics is all about people's actions rather than the consequences of their actions. That is, ethics focuses and emphasizes on what people do and not the results of what they do and the morality or ethicality of a given action is determined by the fulfillment of a duty according to the Kantian perspective (Kozlova, 2015). Under deontological ethics, what we are concerned with is the wrongness or rightness of an action itself as opposed to the rightness and wrongness of the consequences that flow from that action (Mandal, Ponnambath, & Parija, 2016). According to Mandal et al. (2016), under this ethical theory, harm is unacceptable regardless of its outcomes. Additionally, deontologists do not concern themselves with the habits or character of the actor or look at virtues but instead looks at an individual's moral duty and obligation to do the right thing to self and others.

Further, what makes a choice/ decision right or wrong according to deontology is the extent to which it conforms to some established and universally recognized moral norm and principle. Hence, according to Kantian deontology, individuals in the society should always strive to do the right thing because it is the right thing to do and owing to the fact that they have a moral duty to do ethical things. Since right takes priority over good. Kant also warned people against doing wrong things simply because they are wrong and they do not bring any good to others. For instance, deontologists believe in universal moral rules such as the prohibition against killing innocent people. Therefore, an action is considered morally right and good not because it produces good or positive consequences but due to the action's unique moral characteristic.

However, the most important principle of the deontological approach to ethics and which is necessary for understanding the ethics of physician-assisted suicide and euthanasia is the concept of the categorical imperative. By this principle, Kant meant that individuals should at all time act in such ways and manner that their actions could be considered as some universal law due to their moral and ethical content. The categorical imperative was considered by Kant to be an unconditional and absolute requirement condition from which no derogation is permitted. In other words, it represents the highest good that trumps all human desires or will and imposes a moral obligation on individuals to do the right thing at all times without considering the consequences of their actions. According to Kant, the fundamental basis of all moral responsibilities or obligations is the supreme categorical imperative.

Using this principle, Kant also urged people to always treat humanity not merely as a means but also as an end. Under this moral formation by Kant, there are for main ethical duties: imperfect duty to others, perfect duty to self, perfect duty to others, and imperfect duty to self. According to Jordan (2017), of the four duties enumerated by Kant, the ones which are relevant to a discussion of physician-assisted suicide and euthanasia are the imperfect duty to others, perfect duty to self and perfect duty to others. Under the perfect duty to others, one has an ethical obligation to respect other people by, for instance, not lying to them, keeping promises, and not killing innocent people (Jordan, 2017). The perfect duty to self also requires that you do not disrespect yourself by, for example, committing suicide. Hence, the Kantian deontology is against killing oneself as it violates the categorical imperative as a moral principle.

Moreover, the deontological theory of ethics formulated by Kant is based on the duty of beneficence which includes the imperfect duty to others. Hence, according to deontologists, people should treat each other with respect and further or promote their happiness (Jordan, 2017). According to Jordan (2017), on the basis of Kant's duties derived from the categorical imperative, deontologists do not believe there is any justification for physician assisted suicide. For instance, the perfect duty to others and self-condemn any form of killing of innocent people and this would include physician-assisted death and euthanasia. However, under the duty of beneficence, a doctor who assists a patient do die either through euthanasia or assisted suicide "would be creating happiness for the patient who wants to die" (Jordan, 2017, p. 4).

Hence, on this basis, it would be justified to help others take away their lives since it is for their own benefit in that it reduces their pain and suffering, particularly where they are suffering from a terminal disease such as cancer. Nevertheless, even this duty of beneficence would still be contrary to Kant's categories of perfect duties to self and others that are not to be derogated from under any circumstance. According to Kozlova (2015), one of the assumptions Kant makes in his deontological ethics theory is that the fact that self-love cannot be tied to death makes suicide wrong, immoral, and unethical.

In a way, the deontological theory of ethics frowns upon and discourages the practice of euthanasia and physician assisted suicide because they go against the categorical imperative or individuals' moral duties to self and others in the society. According to Kozlova (2015), the Kantian perspective of ethics may be summarized in the maxim "If I suffer in indignity, I should end my own life." This could be interpreted to mean a duty to avoid or prevent suffering from self and promote one's dignity by ending one's life. However, as Kozlova (2015) argues, if this view were to be adopted, no one would remain alive.

The Utilitarian Justification of Euthanasia and Physician-Assisted Suicide

Mostly associated with Jeremy Bentham and John Stuart Mill, the utilitarian theory of normative ethics posits that the question of whether one's action is right or wrong depends only on the consequences or outcomes of that act and the extent to which it benefits a majority of people. Thus, according to utilitarianism, ethics is all about making choices between two or more extreme alternatives and the most ethical choice is usually that which has the overall effect of producing the greatest good for the greatest number of people. Thus, where a person's actions maximize happiness and pleasure, then it is considered ethical while where the actions maximize pain and suffering or unhappiness and displeasure, then such an action is considered as unethical and is to be avoided. Hence, the utilitarian theory of ethics goes over and above individual or personal interests and considers or prioritizes the interests of others. According to Beauchamp and Childress (2001), utilitarianism is thus a type of consequentialism whereby the goodness of an action depends on its effects not just on one particular individual but also on other people.

There can be both active and rule utilitarianism. Act utilitarianism states that the right action, choice, or decision out of many alternatives is the one whose consequences are better or less bad than other available options available to an individual while rule-utilitarianism is generally an exception to a rule which is generally followed by the rest of the society or in a profession. That is, act utilitarianism means the application of the principle of utility to the available alternative acts to determine the best choice which would produce the greatest amount of benefits while rule utilitarianism entails using the utility principle in ascertaining the validity of moral principles or rules of conduct. Bentham's principle of utility equated evil with pain and good with pleasure and is based on the idea that it is possible to approve or disapprove of an action based purely on the amount of pleasure or pain that it brings on people in terms of its consequences for the overall population. This principle was later refined by Mill who argued that it is not the amount or quantity of happiness and pleasure that counts in utilitarianism but rather its quality.

To illustrate the concept of the act and rule utilitarianism and its application to euthanasia or physician-assisted suicide, Jordan (2017) uses an example of a terminally ill patient who is suffering and experiencing excruciating pain as a result of their illness. The patient expresses a wish and intention to have a physician help in speeding up their death through the prescription of a lethal dosage of drugs. Jordan (2017) then argues that in this situation, a rule-utilitarian would come up with a justified exception to the "do not kill" rule by claiming that the decision to help the patient kill themselves is justified by the self-defense exception to a charge of murder. In essence, in such situations, physician-assisted suicide or euthanasia would be justified by an act-utilitarian theorist on the basis that it enables a terminally ill individual to avoid a prolonged painful death which not only benefits the patient but also others associated with him. According to Jordan (2017), the doctors, family members, and the hospital would benefit from such assisted death in that it would save them from unnecessarily spending a lot of money and other resources that would be used to treat patients with prospects of living. Moreover, the patient's family would benefit from assisted death in that they would not have to go through the agony of having to watch their loved one undergo extreme pain and suffering.

Therefore, it is Jordan's (2017) argument that the patient's decision to have a lethal dosage of medication administered on them should be respected as the consequences that will flow from that "will bring about the greatest balance of good over evil" (p. 3). Such a choice or decision would also be justified by the rule-utilitarianism i...