Friday, June 8, 2007

On Euthanasia, Part 2

Medical science has progressed in leaps and bounds, but the fountain of youth remains elusive -- stem-cell research being the closest to attain this panacea. Death ultimately is unavoidable; it is only tempered by the means it is approached. In addressing such an emotionally charged matter, a clear distinction needs to be made between the similar, but cardinally different concepts of Active- and Passive euthanasia:

Active Euthanasia is the express intervention with the purpose to kill for the relief of mental/psychological suffering; or the alleviation of economic burden; or for the convenience of the patient/family/society. This can further be divided into voluntary and involuntary euthanasia. The former is done with the consent or at the behest of the patient or proxy, while the latter is performed without consent.

Passive Euthanasia is the withdrawal or failure to implement artificial life-support in terminal patients, where death seems imminent with no hope of recovery or cure. The physician accepts the inevitability of death – having tried to save and prolong life; the patient is remitted to the forces of nature. In such cases, the disease or injury is the death-causing agent, not any intervention from the physician. This ethical form is practiced in most hospitals.

I’ve already handled the issue of personal autonomy with regards to suicide or ‘surrogate-suicide’ by the physician in part 1 so will take it from a broader perspective:

The only remotely ethical ground that I can see for the justification of voluntary euthanasia is if it believed that the death would be to the benefit of the patient; it would be morally wrong to kill if it were thought that the patient had any prospect of still living a worthwhile life. From this it follows that voluntary euthanasia is only merited when the physician believes that the patient does not have a worthwhile life. This is tantamount to saying that the ongoing life of the patient lacks any value, hence it can be terminated. I find the gall of such a statement repulsive; what hubris to even think of making such a call.

Further, when assimilated into a legal system that purports to enforce a just social order, these concepts are mutually exclusive. How can such killing be legalised on the premise that some lives lack value when justice in society is based on the non-arbitrary and non-discriminatory premises of ineliminable human dignity and worth.

With the acceptance of voluntary euthanasia, the most compelling reason to reject involuntary euthanasia is removed. Is someone can benefit from being killed, is it reasonable to deprive someone from this benefit simply because they haven’t or are incapable of asking for it? At the very least, acceptance of voluntary euthanasia, allows the claim that certain people cannot be harmed by the termination of their worthless lives – they may be allowed to exist on the indulgence of society. Hence one would find the most vocal advocates of voluntary euthanasia also endorse involuntary euthanasia and even infanticide: enemy of civilized humanity #1, Peter Singer, being case in point.

I won’t even bother going into all the complexities of how voluntary euthanasia can result in coerced ‘voluntary’ euthanasia where ‘the right to die’, becomes ‘the duty to die’. With the horrifying onset of HIV/AIDS as a terminal disease, such a ‘culture of death’ would have inestimable results in Africa which has prided itself as a culture of resilience and life.

8 comments:

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Anonymous said...

Two points, and a question:

"Active Euthanasia", for the reasons outlined by you, is not practised; certainly not without consent, unless we're talking about straightforward murder (which is not usually a gentle death). To my mind, active euthanasia is not practised at all. If it is "at the behest of the patient", it is called "assisted suicide".

Your paragraph 6 ("Further, when assimilated ...") is incomprehensible to simple souls such as myself.

As a self-confessed existentialist, could you give me your version of "a worthwhile life"? (hex)

Masgruva said...

Hi hex, as usual thanks for the input.

To my frugal knowledge, I’d say that ‘active, voluntary euthanasia’ is very much practiced. It is ‘legal’ in the Netherlands (doctors are immune from prosecution if it is done by the book), and has been recently legalised in Belgium. It also enjoyed a period of legality in one of the Australian territories if I recall correctly. I noticed on the wiki article that it’s also legal in Albania. In other places such as the Kevorkian’s state of Oregon, ‘Physician-Assisted Suicide’ is practiced under the protection of the law. The way I understand the subtle difference in terminology, is that in physician-assisted suicide, the patient is still the one to press the final button (or swig the swill), although the physician assisted in preparing and administering the concoction, the only difference from active (voluntary) euthanasia, is the physician actually administered the drugs. It’s a case of who did the final act to induce death.

Sorry about paragraph 6; even my colleagues/friends think me too cryptic for meaningful rational discourse. What I meant to say is that euthanasia and social justice as we understand it are logically incompatible – specifically when laws are introduced to recognise ‘Assisted Suicide’. Social justice is based on the fundamental ‘assumptions’ of equal human worth and dignity. Euthanasia assumes that some lives are not worth living. Hence, they are incompatible in my humble opinion.

Existentialism is tricky to define, hence too the meaning of a worthwhile life. It attempts to engage the principal existential questions of ‘Origin’ (where do I come from?), ‘Essence’, (what am I?), and ‘Destiny’ (where am I going?) There’s Sartre’s maxim of ‘existence precedes essence’ – which implies that there isn’t really a pre-cut mould for being. I agree that existence is primary, but do not preclude the discovery of ‘pre-ordained’ transcendent essence. Secondly, there’s the embrace of free-will – the freedom to define life (and hence our ‘Destiny’) – but with it comes the brutal responsibility of living with the choices made. A good life is in acceptance of existence, embracing the choices of life and often the absurdity of it and accepting its responsibility. From this you can see that even the primitive in Papua New Guinea may have a ‘worthwhile life’, while the millionaire snorting crack in his/her penthouse suite may not. Essentially though, this philosophy is concerned with living, not abdicating, our freedom.

Anonymous said...

Thanks for replying, masgruva. First, my apologies for chuntering about 'paragraph 6'; it really wasn't that difficult to comprehend - except for the word 'non-arbitrary'. Whenever I see that word, something in my head (the brain?) shuts down and needs to be re-booted ... you say "social justice is based on the fundamental 'assumption' of equal human worth and dignity". Quite so, but surely there is such a thing as 'the right to die with dignity'? No, don't answer that, I feel we're talking at cross-purposes.

Jean-Paul Sartre says that existence precedes essence, which to my mind is an erroneous assumption. Surely our genes also have a role in what we choose to make of ourselves? The melancholic existentialist Ernest Becker argues that our primary death anxiety "necessarily and quite literally drives us to distraction". He offers an apology for religion as the least destructive form of the universal and necessary denial of death, and that the human situation is so terrible that without our illusions we must go mad. Pretty grim: I can think of much better philosophies than that.

"A good life is in acceptance of existence, embracing the choices of life and often the absurdity of it and accepting its responsibility". I like that a lot; it reminds me of the Stoics, who advocated calm acceptance of the natural order, the goal being the intrinsically honourable and dignified life, stripped of comforting illusion (one of the many 21st-century features of Stoical thought was its approval of suicide when life with dignity becomes impossible, but I think we should let that pass). Of course, the Stoics also believed that the spark of the soul was reabsorbed into the great fire of the cosmos: a fanciful notion, considering there is no such thing as a 'soul'.

Masgruva said...

Apologies for the delayed response. It seems that working, combined with studying, is detrimental to blogging. No worries about your "chuntering", I guess I deserved it with such a mundane section of prose.

We are indeed talking at cross purposed. I think our difference fundamentally lies in that we don't agree on the effects this would have on the wellbeing of society. I assume that you consider assisted suicide an innocuous activity that should be reclassified as a virtue. I however, see assisted suicide as a very real threat in manipulating public perception to the creation of a "slippery slope", viz. Nazi Germany’s T4 program, the Netherlands’ Groningen Protocol where this country has moved from active voluntary, to active involuntary and notably with the case of 'Baby Maarjte' to sanctioned infanticide. See the following links:

http://www.brusselsjournal.com/node/297
http://www.wesleyjsmith.com/blog/2005/04/belgium-falling-off-infanticide-cliff_07.html
http://www.nationalreview.com/smithw/smith200503220759.asp
http://www.chninternational.com/chninfo3.htm

If one were to accept this slippery slope, I think my views are rightfully vindicated.

As for Sartre, his maxim was formulated in rejection of the "divine blueprint". The notion of free will is rather more complex, but I find ‘compatibilism’ a suitable compromise. Genes do play a role, certainly, but responsibility still lies with the moral agent.

Anonymous said...

I can hardly bring myself to talk about this subject matter yet again, masgruva, but I'd hate to disappoint you, so here goes.

You assume that I "consider assisted suicide an innocuous activity that should be reclassified as a virtue". Well, I wouldn't put it in exactly those words, but basically you quite correct in your assumption. Euthanasing new-borns who are suffering terribly, with no hope of improvement and no way to ease their suffering would in my view be an act of compassion; no more, no less. Or do you seriously believe it would be better to treat these unfortunate infants in the way it's always been done: put them into a corner, without nourishment or other comfort, and check on them occasionally to see if they have died 'naturally', which can take a very long time. I find that diabolically cruel, and to talk about 'sanctioned infanticide' as the slippery slope leading to Tiergartenstraße No4 is a very long shot indeed.

Speaking of slippery slopes, imagine a world-wide killer epidemic (bird flu?) in which only immunization would save people's lives. But there's a problem: the life-saving vaccine is in short supply, and the powers-that-be decide to only give it to young people (they still have their lives ahead of them!), and leave older people to their fate (they are 'useless mouths'). Now that's where I think things get slippery, although I can see the logic behind such a decision. By the way, that's exactly what the WHO recently proposed. (hex)

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