Euthanasia: A Question of Ethics
Euthanasia is one of the most acute and uncomfortable contemporary problems in medical ethics. Is Euthanasia Ethical? The case for euthanasia rests on one main fundamental moral principle: mercy.
It is not a new issue; euthanasia has been discussed-and practised-in both Eastern and Western cultures from the earliest historical times to the present. But because of medicine's new technological capacities to extend life, the problem is much more pressing than it has in the past, and both the discussion and practice of euthanasia are more widespread.
Euthanasia is a way of granting mercy-both by direct killing and by letting the person die. This principle of mercy establishes two component duties: 1. the duty not to cause further pain or suffering; and 2. the duty to act to end pain or suffering already occurring. Under the first of these, for a physician or other caregiver to extend mercy to a suffering patient may mean to refrain from procedures that cause further suffering-provided, of course, that the treatment offers the patient no overriding benefits. The physician must refrain from ordering painful tests, therapies, or surgical procedures when they cannot alleviate suffering or contribute to a patient's improvement or cure. Perhaps the most familiar contemporary medical example is the treatment of burn victims when survival is unprecedented; if with the treatments or without them the chances of the patient's survival is nil, mercy requires the physician not to impose the debridement treatments , which are excruciatingly painful, when they can provide the patient no benefit at all. Although the demands of mercy in burn contexts have become fairly well recognized in recent years, other practises that the principles of mercy would rule out remain common. For instance, repeated cardiac resuscitation is sometimes performed even though a patient's survival is highly unlikely; although patients in arrest are unconscious at the time of resuscitation, it can be a brutal procedure, and if the patient regains consciousness, its aftermath can involve considerable pain. Patients are sometimes subjected to continued unproductive, painful treatment to complete a research protocol, to train student physician, to protect the physician or hospital from legal action, or to appease the emotional needs of family members; although in some specific cases such practises may be justified on other grounds, in general they are prohibited by the principle of mercy. Weather a painful test or therapy will actually contribute to some overriding benefits for him or her, they should not be done.
In many such cases, the patient will die whether or not the treatments are performed. In some cases, however, the principle of mercy may also demand withholding treatment that could extend the patient's life if the treatment is itself painful or discomforting and there is very little or no possibility that it will provide life that is pain-free or offers the possibility of other important goods. For instance, to provide respiratory support for patient in the final, irreversible stages of a deteriorative disease may extend his life but will mean permeant dependence and incapacitation; though some patients may take continuing existence to make possible other important goods, for some patients continued treatment means pointless imposition of continuous pain.
The principle of mercy may also demand letting die in a still stronger sense. Under its second component, the principle asserts a duty to act to end suffering that is already occurring. Medicine already honours this duty through its various techniques of pain management, including physiological means like narcotics, nerve blocks, acupuncture, and neurosurgery. In some cases pain or suffering is severe but cannot be effectively controlled, at least as long as the patient remains sentient at all. Classical examples include tumours of the throat,...
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