The term Euthanasia is derived from two Greek words: eu, which means well or good, and thanatos, which means death.
There are a number of other terms in the debate over euthanasia that call for explanation.
Voluntary / Involuntary / Non-voluntary
These terms focus on whether or not the patient requests death or grants permission to be put to death.
· Voluntary euthanasia refers to those instances where a patient does request death. This is often regarded as the equivalent of suicide.
· Involuntary euthanasia occurs when someone is put to death or allowed to die against their will or wishes (most ethicists would regard this as murder).
· Non-voluntary euthanasia is when the patient isn't able either to give or withhold consent due to an irreversible comatose state. In this instance, the person failed to give any prior indication about what his/her wishes might be.
Many ethicists believe that only certain kinds of voluntary euthanasia can be morally justified.
Active / Passive
These terms address the kind of action taken to cause the death of the patient. Active euthanasia refers to taking some form of purposeful action to bring about death, whereas passive euthanasia refers to the withholding of life-sustaining treatment or perhaps the withdrawal of treatment already begun.
Many look at the difference between active and passive euthanasia as equivalent to the difference between killing someone and letting someone die.
Direct / Indirect
Whereas the terms voluntary/involuntary/non-voluntary refer to whether or not the person requests or permits the act by which he dies, the terms direct/indirect denote the role played by the person who dies when his life is taken. Direct euthanasia means the person himself carries out the decision to die. Indirect euthanasia refers to the situation where someone else carries out the decision. In other words, direct/indirect refers to whether or not the person does the act himself.
When these terms are combined, we come up with two broad categories of euthanasia, within each of which are several options:
1. Voluntary Euthanasia
In this case, the person desires death and he himself takes direct, purposeful action to end his life. This is hardly distinguishable from suicide.
Here the patient requests death and acquiesces to the action taken by another to end his life. For example, if an AIDS patient asks a friend to administer a lethal dose of drugs, we have a case of indirect-active-voluntary euthanasia.
N.B. The activity of Dr. Jack Kevorkian of Michigan is a strange combination of these first two categories. Consider this example.
Janet Adkins was diagnosed with Alzheimer's disease at the age of 54. When she learned of the nature of the disease and what the future held for her, she decided she did not want to live in that condition. She enlisted the help of Kevorkian, who hooked her up to his infamous suicide machine. On June 4, 1990, Janet Adkins pushed a button that released lethal chemicals into her blood stream. She died a painless death in five minutes.
Clearly this is a case of voluntary, active euthanasia. But given the role played by Kevorkian, it could be classified as either direct (Janet Adkins actually pushed the button) or indirect (Kevorkian hooked her up to the machine).
Question: What if, after requesting Kevorkian's assistance, she lapses into a coma? Kevorkian only then hooks her up to the machine and himself pushes the button. Is it murder or suicide?
Here the patient requests death and acquiesces to the action taken by another to withhold treatment that would otherwise sustain life.
In this situation, the patient requests death and refuses any efforts of others to administer life-sustaining treatment (or perhaps through a living will gives legal directives that, should he be rendered comatose and terminal, no life-preserving measures be employed).
2. Non-voluntary Euthanasia
Obviously, all non-voluntary euthanasia is indirect, for if a person does not desire or request death, he/she cannot be the one who administers death.
Here the patient did not request death. However, another person takes purposeful action to end the patient's life.
It would appear difficult to differentiate this from simple murder. Appeal is frequently made to the motive for taking the patient's life. If it is done to release the individual from incessant and excruciating pain, which only death would accomplish, some refer to this as mercy killing.
Here the patient did not request death. However, another person withholds life-sustaining treatment.
Selected Case Studies
(1) On August 26, 1981, while in the recovery room following routine surgery, Clarence Herbert suffered a massive loss of oxygen to the brain and became comatose. He was put on a respirator. Although his brain still performed minimal, lower brain functions, his wife was informed that he was brain dead. She agreed to have him removed from the respirator. But he did not immediately die. Two days later the doctor ordered withdrawal of all intravenous feeding. Six days later he died of dehydration and pneumonia. Was this mercy or murder?
(2) Consider this hypothetical but not unreasonable scenario: John Davis is strongly pro-life. He has been an outspoken opponent of both abortion and euthanasia, whether active or passive. At the age of 43 John has a swimming accident in which he appears to have drowned. He is resuscitated on the way to the hospital, but never regains consciousness. He is later classified as being in a Permanent Vegetative State, known in the medical community as a PVS. He has no mental activity whatsoever: no feeling, thought, emotion, or self-awareness. All higher brain function is lost. Before his accident, John had himself argued against any form of euthanasia for someone in the state in which he now finds himself. His family wants to honor his convictions, but the medical expense has brought them to the verge of bankruptcy and emotional disintegration. John's wife, Margaret, was pregnant when the accident occurred and recently gave birth to twin boys. These are their fourth and fifth children.
Margaret is advised by her family and friends to sign a release that would allow the hospital to withhold any additional life-saving measures as well as to unplug the respirator, apart from which John would surely die. Is she morally obligated to sustain his "life"? Or does she have a higher moral obligation to her children? If John should die, Margaret stands to receive a sizable, and more than adequate, insurance settlement. What advice would you give her?
(3) Ralph was terminally ill with incurable stomach cancer that was spreading throughout his abdominal region. His body was wasting away and the pain was unbearable. No amount or kind of medication could alleviate the growing intensity of his pain. Although Ralph had never expressed his opinion on euthanasia prior to his cancer, now, in the midst of his agony, he asks his physician to "put him out of his misery" by administering a lethal injection of morphine. What should the doctor do?
Does the fact that he makes the decision in less than ideal circumstances and in a less than ideal mental and physical condition play a role?
(4) The case of Nancy Cruzan drew international attention. On January 11, 1983, twenty-five year old Nancy was in a car accident in southwestern Missouri. Although paramedics were able to restart her breathing, she had been without oxygen too long and never regained consciousness. On Feb. 5, 1983, doctors put a feeding tube in Nancy's stomach. She was not on any other form of life-support system. For the next few years she remained in a permanent vegetative state.
In 1987 her parents petitioned the court to have their daughter's feeding tube removed, allowing her to die as they believed she would want. A Missouri county judge granted their request but the Missouri Supreme Court overturned the decision.
The Cruzan's appealed to the U.S. Supreme Court, which ruled 5-4 against their request. However, as the Feinbergs point out, "the decision was not based on a belief that food and water could not be removed because they are basics of patient care and are not medicine. Nor was it based on a belief that patients do not have a right to choose to die. Instead, the ruling came because there was no clear and convincing evidence that Nancy would have wanted to stop artificial nutrition" (102). If Nancy had written a living will expressing such a desire or had granted power of attorney to a family member to make such a decision on her behalf, the court would have ruled in favor of her parents' request.
In 1990 the Cruzans returned to the Missouri court and presented evidence that their daughter had once told three people she would rather die than live in a permanent vegetative state. On December 14, 1990 the Judge ruled that the Cruzans could remove Nancy's feeding tube. They did, and Nancy Cruzan died shortly thereafter.
N.B. A crucial factor in assessing such cases as these is one's definition of death. The Ad Hoc Committee of the Harvard Medical School defined death (irreversible coma) by four criteria:
1) unreceptivity and unresponsivity (no stimuli of any sort evoke any kind of response);
2) no movements or spontaneous breathing for at least an hour;
3) no reflexes, and fixed dilated pupils;
4) flat brain wave (flat EEG) for at least ten minutes, preferably twenty.
"All four must apply, and they must still be true of the patient twenty-four hours after first tested" (Feinbergs, 123).
A. Arguments in Favor of Euthanasia
The argument is simple: someone in an irreversible coma is no longer a person but only a biological organism. The distinction is often made between a person's biological life, or physical existence, and one's biographical life, or the aspects of one's life that make it meaningful. One's biographical life is the sum total of one's goals, desires, dreams, plans, accomplishments and relationships. Medical science has made it possible to retain one's biological life after having lost one's biographical life. Thus the individual exists only as a body, having lost the essence of what it is that makes him/her a person. Hence it is not murder to terminate what remains of one's mere biological existence.
2. Quality of Life
In cases of unrelenting and unrelievable suffering where there is no reasonable hope of improvement, life ceases to be worth living. In such cases, an individual or his/her family ought to be free to say "enough is enough" and put an end to such incessant misery. No one should be compelled to live a life that they no longer regard as life worth living.
We extend mercy to animals when we put them out of their misery. Why should we be less merciful to humans?
James Rachels argues as follows:
"If one simply withholds treatment, it may take the patient longer to die, and so he may suffer more than he would if more direct actions were taken and a lethal injection given. This fact provides strong reason for thinking that, once the vital decision not to prolong his agony has been made, active euthanasia is actually preferable to passive euthanasia, rather than the reverse. To say otherwise is to endorse the option that leads to more suffering rather than less, and is contrary to the humanitarian impulse that prompts the decision not to prolong his life in the first place" ("Active and Passive Euthanasia," The New England Journal of Medicine, 9 Jan. 1975, p. 78).
4. Utilitarian concerns
Most people cannot afford to underwrite the expense of keeping a terminally ill or comatose person alive. To do so places an unfair burden on other members of the family. Why should tax dollars and precious hospital space and technology be expended to perpetuate the life of someone who will never function in society again when there are other, potentially productive people, who cannot receive proper care?
B. Arguments Opposing Euthanasia
1. The Sanctity of Life
Human life, because created in the image of God, is sacred. No measure is too extreme, no cost too high, to preserve what God has made.
2. Biblical prohibition vs. life-taking
Killing the innocent is condemned in both the OT and NT.
Medical history is filled with examples of people thought to have incurable/terminal diseases who were later healed when medical knowledge increased.
4. The value of suffering
The Bible says that people grow and mature and deepen in their understanding of and trust in God when they endure suffering. In other words, there is a sanctifying effect in physical suffering.
5. The biblical perspective on death
Death is the final indignity, no matter what form it takes. Death is the last enemy, to be resisted, not embraced.
6. Divine healing
7. The Slippery Slope
As Rae explains, "It is not hard to see how family pressure and mounting medical bills that eat away at the patient's estate could coerce one into consenting to ending one's life, not because the patient was tired of living but because others were tired of the patient living" (173). Added to this are concerns that this slippery slope will lead to a situation in which eventually "euthanasia will not be restricted to the terminally ill. Rather, it will be extended to people with varying quality of life circumstances. Opponents [of active euthanasia] fear that candidates for euthanasia will include the nonterminally ill, such as people with Alzheimer's disease or other degenerative brain diseases, the severely mentally retarded, and handicapped newborns" (Rae, 173).