Euthanasia etymologically is made up of two Greek words “eu” denoting good and “thanatos” denoting death, literally meaning “an easy or a good death”1. The modern meaning is that of “mercy killing” first used in the sense in England in 1869. ‘Mercy killing’ or’ Euthanasia’ signifies the act of killing a person, for the sake of the person being killed ,who is terminally ill in great pain and distress, without the hope of recovery in spite of the medical advancements and is killed, to relieve him of his misery in a painless manner. Euthanasia raises a number of ethical issues regarding human agents involved, the autonomy of the agents, rights of the agents, and some religious and legal issues.
There are some distinctions within Euthanasia which need to be stated to clarify the understanding of the ethical issues involved. They are as follows;
1. Active Euthanasia and Passive Euthanasia,
These are the three distinctions within euthanasia which raise different ethical issues when viewed separately and distinctly. A brief discussion of the above stated distinction within euthanasia would make the ethical issues involved within them clearer and meaningful.
1. Active and Passive Euthanasia
Active euthanasia occurs in those cases where there is an act of commission by such persons who are willing to use some of the means available, for instance a lethal injection, to bring about a person’s death. And, Passive Euthanasia occurs in those cases where the person simply refuses to intervene in order to prevent someone else’s death, whether by not doing something or by stopping to do something that could keep the person alive. Whether the act is of commission or of omission, they ultimately lead to the person dying.
Many people raise a moral distinction between Active and Passive Euthanasia. They argue that it would be morally acceptable to withhold treatment and let the person die, rather than to deliberately end the person’s life and let nature take its course, thereby committing a sin and a murder. This moral distinction it seems is superficial because the intention and the result in both the cases is the same namely the death of the person concerned. More than being a moral refrain in the case of active euthanasia it is a legal one. In most of the countries Assistance to a patient for Euthanasia is equated with murder. In both the cases the intention remains the same while the method changes, the former of acting in a certain way and the latter in its refusal to act in that manner leading to the death of the person. Thus, the act of omission is just as much an act of killing as is the act of commission in a way to bring about the death of the person.
Simon Blackburn explains the doctrine of acts and omissions like this in the Oxford Dictionary of Philosophy:
The doctrine that it makes an ethical difference whether an agent actively intervenes to bring about a result, or omits to act in circumstances in which it is foreseen that as a result of the omission the same result occurs.
Thus suppose I wish you dead, if I act to bring about your death I am a murderer, but if I happily discover you in danger of death, and fail to act to save you, I am not acting, and therefore, according to the doctrine, not a murderer.2
The doctrine does little to make the perspective clearer. Suppose that, A and B are aware that they will inherit the family fortune only after their father C dies. Their father is ill and has to be on constant medication to go on living. Both, A and B want to inherit the wealth quickly and would rather see that their father dies. Now, A kills his father by hitting his father on the head and disguises it as an accident. While B does not replenish the supply of his father’s medication and eventually lets him die. In a court case A is guilty of murder and B gets away. At the hearing B says that he didn’t do anything except not bring his father’s medication thereby letting him die. Now, that wouldn’t be very nice would it? 2
Would this example help in the case of euthanasia? The point in case is the intention of the agents involved. In the above example and in the case of active and passive euthanasia all the agents have the intention or at least the awareness of the consequences of the respective acts and omissions, so how would the one act that of just letting a person die or actually killing a person qualifies as a better moral act?
Having stated the arguments from the perspective of the agent executing the act of delivering death to the person, it would now be worthwhile to look at the case from the perspective of the person being delivered death. Would a person under normal circumstances consent to dying? Every person values life as much as any other human being. Why then, would a person consent to end his own life? A person would consent to end his life only and only if life has become unbearable or there is certainty of death. When the last ray of hope has diminished from his life and the survival instinct has died. Let us assume that a person has reached such a point in his life. What should he do to act morally? Would he want to die a peaceful, painless death with his loved ones near him? Or would he be willing to die a painful death? Obviously everyone would choose the former. If we choose the former then active euthanasia is a better choice, and thereby, is it a better moral act?
Since the inevitability of death looms and there is no doubt that the person is going to die, either if relieved of life at this stage peacefully or if his life is prolonged in pain and misery. So given the circumstances the better option would be to act in order to relieve him. Assist him in Suicide. The practice of active euthanasia will benefit him more than that of passive euthanasia which will prolong life without any significant enhancement to it will cause more pain and suffering. While active euthanasia will allow him to die while he is still at peace and has respect for his life. Life for the sake of life has no value in itself. Life has value from the hope we derive from the future. The hope a person invests in the future for his loved ones and himself. The ideal of a better life presupposes the hope for the better future.
The argument from the sanctity of life is as follows;
Life is a gift from god, we have no right to decide whether to live or die and only god can decide.
To rephrase it;
God gave us life we should respect it and endure all hardships that come with it. We should not only respect it but also care for the dying and the sick, because life is priceless. And, we have no power to decide over life and death questions only God has that power.
The argument can be shown to be weak because if God gave us the gift of life and he is a good God then, the good god would not want his beneficiaries to suffer this gift of life. He on the contrary will certainly want them to have relief from their suffering. And if he would want them to suffer and not be relieved of it then he is not a good God. So in this case since he is not a good god we can take the decision against sanctity of life. The problem of viewing death as a negative category is what makes us see the ending of life as a bad thing. In the religion of Jainism the Jain monks end their lives committing suicide by renouncing food and water, there by starving to death. They first take a vow called the sallekhana vrata, and then commit the ritual of sallekhana. Do they commit a sin? Is it morally unacceptable? Or is it viewed as the final act of the utmost religious life?
2. Voluntary, Non-voluntary and Involuntary Euthanasia
Voluntary euthanasia is that instance of euthanasia in which a clearly competent person makes a voluntary and enduring request to be helped to die.4 An example below illustrates this;
Jones was dying from a progressively debilitating disease. He had reached a stage where he was totally dependent on a respirator and was almost paralyzed. He was suffering considerable distress and knew it would get worse as time went by. He requested his doctor to end his life and save him the suffering. The doctor in consultation with his family and the medical staff administered a lethal injection, and Jones died.
This is a clear case of Voluntary euthanasia. Euthanasia can be voluntary even if the person is no longer competent to assert he wish to die. The person may wish to end his life if he was ever to be in a situation where he suffers from an incurable disease, and, should he be in no position to decide.
Non-voluntary Euthanasia is that instance of Euthanasia where a person is not competent to decide between life and death.
Jones met with an accident which left him in a condition of total paralysis and destroyed most of his cognitive functions, leaving him totally incompetent to decide between life and death. He had never indicated a wish to die in these circumstances or a wish stating the contrary. The doctor nevertheless decides that it was better if Jones was to die and injects him with a lethal injection. Shortly after which Jones died.
And, involuntary Euthanasia is that instance of Euthanasia where a person is competent to decide between life and death, but has not given consent either because she was not asked or because she was asked but withheld consent.
Mary was infected with leukemia and had few months to live. Her husband Jones didn’t want to see his wife suffer to the end and so he shot her. She died.
The most important argument for the permissibility of voluntary euthanasia is the argument from autonomy. It follows that we should respect the autonomous decisions of rational individuals. Since the debate regarding euthanasia emphasizes competence of the rational agent autonomy presupposes competence. Most rational agents make decisions throughout life and want to live without coercion or interference in their lives, why should the decisions of life and death be treated differently? Because, if this is to be the case then the respect for autonomy will soon turn out to be discretionary and will eventually loose respect for autonomy and assist them to do as they would so choose. In a society no individual can be permitted to do as she or he feels like action solely on the basis for autonomy, with disregard for societal conventions. Now, if this were so then morality would be the result of convention, but clearly that is not so. Therefore the argument from autonomy though rational and cogent can easily be construed and eventually lead to discretionary choices, where it would become increasingly difficult to draw a line between a competent and rational decision as opposed to an emotional and irrational decisions. This argument can also be seen as justifying suicide, where an individual chooses to die because he so chooses or under emotional or other influence.
The weight of the case for allowing Euthanasia rests on the percept that ‘death would be better that life’ in the certain circumstances. In order to have a comparative conclusion of the form stated above we need to have access to information regarding both the cases before coming to a conclusion. To compare life which we certainly have a lot of information about, to death about which we know absolutely nothing is fallacious and is merely an assumption. And decisions of life and death are far too important to be based on assumptions. All we can do is assert that this state is not conducive to human dignity, but by no stretch or imagination can we affirm that death would be a more conducive alternative to the present state.
The third parajika, the monastic rule prohibiting taking human life; Buddha says,
Should any monk intentionally deprive a human being of life or look about so as to be his knife-bringer, or eulogise death, or incite [anyone] to death saying ‘my good man, what need have you of this evil, difficult life? Death would be better for you than life’- or who should deliberately and purposefully in various ways eulogise death or incite anyone to death; he is also one who is defeated, he is not in communion.
This implicitly states that assisted suicide and euthanasia leading to the taking of a human life is to be abstained. It would give a clear normative position in the Buddhist ethical stand to notice that the Buddha prohibits assistance to suicide and not suicide itself.
Buddhism as a way of life is opposed to violence in any form, to any living being and in thought and in action. Taking of life is strictly prohibited but there are certain cases where exceptions were made, especially in the case of medical circumstances. In Buddhist ethics more weight age is given to intention and the circumstances than to the action itself. It is the preceding aim of the succeeding action that would constitute the final judgments on the moral value of the action as being good or bad.
Compassion in the Buddhist ethics is of great importance, while compassion is always a morally good motive, it does not justify anything and any act done in its name. Euthanasia is usually understood to be granted the wish of death to a dying person out of compassion or mercy. Buddhagosha‘s commentary on the text of the preceding passage the person euthanizing a dying person, although acts with a compassionate and benevolent motive, violates the percept on taking human lives as propounded by Buddha. Why? Because the person euthanizing makes death his aim, thought having a benevolent motive. As Buddhism is opposed to any thing leading to the destruction of human life, euthanasia cannot amount to being a good moral act. The Buddha it seems did not agree with the respect for autonomy principle, whereby an individual has a freedom to choose between life and death.
Is Buddhism advocating sanctity of live? That life must be preserved at all costs. Buddhagosha in his commentary shows this not to be the case. He says;
If one who is sick ceases to take food with the intention of dying when medicine and nursing care are at hand, he commits a minor offence (dukkata). But in case of a patient who has suffered a long time with a serious illness the nursing monks may become weary and turn away in despair thinking ‘when will we ever cure him of his illness?’ here it is legitimate to decline food and medical care if the patient sees that the monks are worn out and his life cannot be prolonged even with intensive care.
In the above commentary intention and the view toward death of the person wanting to be euthanized is given importance, which is central to Buddhist ethical thinking in matters of life and death decisions varying from suicide to murder to euthanasia. The distinction made is between a person who intentionally rejects medical treatment with the aim of dying and a person, who accepts the inevitability of death after medical treatment and the nursing has failed to cure him, resigns to his fate. There is significance placed in the way one views life as opposed to death. The first one see life as burdensome as thereby intentionally wishes to die, whereby he contradicts the first percept of Buddhism that life is full of suffering, while the second has to be indifference to death by accepting it. Buddhism therefore places no moral obligation to preserve life at all cost. The saving of life at all cost is see due to delusion (moha) and attachment (trsna), the remedy to which Buddhism prescribes and describes in the four noble truths.
Struan Hellier writes about death with regard to the view of death in Buddhist ethical thinking;
Buddhism sees death not as an end to life, but merely as a transition to another life. Anyone who thinks of death as an end to suffering has misunderstood the First Noble Truth which clearly states that death itself is one of the most basic aspects of suffering and that in this way it is the problem, not the solution. An arhat will not commit suicide because he cannot wish for death (or life). When death comes, it comes and can only be met with indifference otherwise the arhat has revealed himself to be less than enlightened.7
There can be no conclusive case for or against euthanasia, where every instance can be accounted for, transparency expected while executing the act or more importantly the intention behind the decision made to die. The discussion can at the most make clear the understanding of euthanasia as an act but clearly there is nothing to suggest that will lead to a conclusion on its moral efficacy. This has been a problem in Ethical thinking, and moral action. The conclusion in two case often are contrary leading to moral dilemmas, and again there is bound to be difficulties as societal understanding of the various phenomenon change , leading some of them to be accepted, while still opposing others. Moral thinking will always pose a challenge to have an objective conclusion on the basis of which and moral agent can act. Again there is a problem of some societies accepting the practice while the others still reject the same.
Euthanasia as an moral issue will be bound to be mired with controversies and contradictions. The is mainly due to the fact that concerns the death of a human being.
2. Simon Black burn- Oxford dictionary of Philosophy
3. James Rachel makes a similar argument.
4. Voluntary euthanasia – Stanford encyclopedia of philosophy
5. Damien keown A very shot introduction – Buddhist ethics Page No-108
6. Damien keown A very shot introduction – Buddhist ethics Page No-112
7. Wiltshire 1983,134,cited in Struan helier ‘suicide and buddhism’,2003
Voluntary Euthanasia –Stanford encyclopedia of Philosophy, http;//plato.stanford.edu/entries/euthanasia-voluntary/
Practical Ethics – Peter Singer, Chapter 7-Taking lives-Human
Euthanasia – Helga kuhse
A very short introduction – Buddhist Ethics – Damien keown, Oxford University press