Euthanizing patients is a controversial medical practice around the world. No other modern medical practitioner ever caused a stir in the medical field than Jack Kevorkian. The pathologist created controversy when he claimed to have assisted 130 terminally-ill patients to commit suicide and sent a 60 minutes videotape to a television news show, in which he was seen helping one of his many clients to die, to substantiate his claims. Although the action made him serve seven years in jail for second-degree murder, its consequences ignited a public debate morality of Euthanasia. The American Medical Association disowned Kevorkian's activities and described them as unethical while some members of the public viewed Kevorkian's actions as ethically sensitive physician with genuine desire to help his patients (Schneider, 2011). The question that many asked (and continue to do so) is: Was it ethical for Dr. Kevorkian to assist terminally-ill patients to die? Yes, I do think that it is ethical for physicians to assist terminally-ill patients to die. In this essay, I use the Utilitarian and Kantian ethical theories to back my position.
A utilitarian approach to ethics uses two parameters to determine whether an action is right or wrong; whether the action causes of pain or pleasure. Utilitarianism considers the consequences of an action as the only motivator for a given course of action in the context of alternatives. According to this view, if assisted suicide increases happiness and reduces the pain of the patient, then it is an ethical thing to do in assisting the terminally ill patients to die (Singer, 2003; Mandal, Ponnambath, & Parija, 2016).In context, patients with terminal illness undergo excruciating pain. This happens in spite of overwhelming medical evidence that they would not survive for a long time. From a utilitarian perspective, it brings more good to the patients to assist them die than leaving them alive under pain only to die a few days or months later. Although critics argue that the pleasure one gets when they are dead is not measurable and some patients may not be rational in making judgments about their fate when terminally ill (Chambers, 2005), it is critical that terminally-ill patients be given the liberty to choose that which is pleasurable for them because they are the only ones who feel the full force of the pain. As argued by Harris (2005), human beings, no matter the extent of their mental impairment, possess a fundamental worth and dignity which cannot be lost as long as they are alive (p.3). Accordingly, the concern of rationality can be addressed through consultations with physicians, patients and the patients' relatives. For instance, in 2014, Brittany Maynard moved from Portland, California, to Oregon to utilize the state's law of euthanasia. Her wish was discussed and agreed within the family (Slotnik, 2014), enabling her to escape the torment of brain cancer, a condition that would have, in any case, ended her life within six months.
The Kantian theory of ethics espouses morality of duties of human beings as the basis upon which actions should be based. Contrary to utilitarianism, Kantianism holds that the rightness or wrongness of an action does not lie in its consequences but its ability to fulfill a given moral duty. Kant described the basis of any action as a consequence of what he described as a categorical imperative (Misselbrook, 2013; Harris, 2005). Although Kantianism appears to contradict pro-euthanasia perspectives, a closer examination of his interpretation of what constitutes moral duty gives the theory a lot of relevance in advocating for the ethical rightness of physician-assisted suicide. This can be done by exploring the duty of self-preservation inherent in Kant's postulations. According to Cholbi (2014) and Cooley (2007), Kant allowed disregarding of the duty of self-preservation in the presence of other compelling moral duties. He appeared to acknowledge the duty to die when individuals are confronted with dilemma. That is to say, when individuals are forced to live under circumstances that deprive them of the full moral agency, it ethically right to allow themselves to be killed. For instance, Kant expresses admiration for Cato the Younger's choice to commit suicide over serving as Caesar's puppet. For Kant, if Cato the Younger had agreed to serve as Caesar's puppet, he would have lost his moral agency. In other words, he chose the option that sustains 'moral life' over physical life (Cooley, 2007). In context, terminally-ill patients face this dilemma. Extreme pain, depression, anxiety, and inability to live a normal life erode the moral agency of these patients. Under these conditions, taking the suicide route becomes a more compelling moral duty .As Cholbi (2014) puts it, suicide does not end the moral life of a sick person; it ends an undignified condition of a formerly rational moral agent. In this sense, such duty is ethically right.
It is ethically right for physicians to assist terminally-ill patients to die. Terminally-ill patients experience excruciating pain, anxiety, depression, and lack ability to discharge their duties as normal human beings. Based on the utilitarian view, denying assistance to commit suicide confers more harm to them because suicide has the potential to relieve them of the enlisted forms suffering. From a Kantian perspective, the experience of extreme suffering, a short prognosis, and the inability to go about their daily activities denies them the moral self-preservation in favor of 'self-love' thereby necessitating for assistance to end their lives. However, the aspect of assisting needs to be explored in future research to expand knowledge on the circumstances under which a decision (by the patient or doctor or both) about euthanizing terminally patients can be made.
Cholbi, M. (2014). Kant on euthanasia and the duty to die: clearing the air. Journal of Medical Ethics, 41(8), 607-610. doi:10.1136/medethics-2013-101781
Cooley, D. R. (2007). A Kantian moral duty for the soon-to-be demented to commit suicide. The American Journal of Bioethics, 7(6), 37-44. doi:10.1080/15265160701347478
Harris, I. (2005). Ethics and euthanasia: natural law philosophy and latent utilitarianism. Australian Association for Professional and Applied Ethics 12th Annual Conference, 1-11.
Mandal, J., Ponnambath, D., & Parija, S. (2016). Utilitarian and deontological ethics in medicine. Tropical Parasitology, 6(1), 5. doi:10.4103/2229-5070.175024
Misselbrook, D. (2013). Duty, Kant, and Deontology. British Journal of General Practice, 63(609), 211-211. doi:10.3399/bjgp13x665422
Schneider, K. (2011, June 3). Dr. Kevorkian dies at 83: A doctor who helped end lives. The New York Times [New York].
Singer, P. (2003). Voluntary euthanasia: A utilitarian perspective. Bioethics, 17(5-6), 526-541. doi:10.1111/1467-8519.00366
Slotnik, D. E. (2014). Brittany Maynard, death with dignity ally, dies at 29. The New York Times [New York].
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