Originally published 4 May 2016

Currently, I am taking a Coursera (online university courses) on Practical Ethics. Next to lectures and readings the course also consists of writing assignments, this is the second one. In this short essay, I am defending legalized physician-assisted suicide and voluntary euthanasia. Disclaimer: This essay reflects my opinion as written in April 2014, this may be different from my current opinion.

Should we legalize physician-assisted suicide, along the lines of Oregon’s Dying With Dignity Act? Would you give the same answer if the question were about legalizing voluntary euthanasia, along the lines of legislation in The Netherlands?

John has lived a full life. He has enjoyed the experience of having a loving family, success in his career, and has a legacy to leave behind. But in the last years, and especially the last few months he has been in incredible pain. He is likely to die within a year but has decided he wants to end it now. His physician administers a lethal injection. In the company of his loving wife and children, he says goodbye one last time, and dies with dignity.

The story of John is, outside of The Netherlands, Belgium, Luxembourg, only a dream. Voluntary euthanasia (VE), giving lethal injection by a physician, and physician-assisted suicide (PAS), giving a patient the means to end his or her life, are prohibited in most of the world. VE and PAS are both voluntary ways of ending one’s life as decided by a capable person (this article will not, nor wishes to, defend non-voluntary euthanasia). The moral difference lies in that VE is an ‘act’ (e.g. lethal injection) and PAS is an ‘omission’. This essay will defend both VE and PAS, consider counter-arguments and show why these are not substantive.

A competent person should be respected in making autonomous choices, as long as it doesn’t result in harm to others. Therefore a person should have the ability to end life. VE in extension should also be legal. A physician is also autonomous in choosing to assist in VE or PAS. To the same extent the author does acknowledge that based on the same reasoning that when a physician’s morals are counter to that of the patient, a transfer of patient can be made.

A first argument can be made against the ‘active’ killing as done by the physician or the patient. The wrongness of killing however is not there when 1) the person doesn’t want to go on living, 2) it doesn’t deprive the victim of positive experiences in the future, and 3) doesn’t cause grief to the ones that love that person. A related argument concerns the ability of a person to make the first judgment competently. It is true that a person’s perception can be blurred by many medications. This is however 1) not true for all patients, 2) could be decided up-front, and 3) is actively countered by using a cool-down period.

A second argument against voluntary euthanasia states that it is not permissible to act in ways in which bad consequences are foreseen. The ‘doctrine of double effect’ states that this kind of act is only possible when four conditions are met. For our argument the third is of most importance: “the good effect is not achieved by way of the bad, that is, the bad must not be a means to the good”. But as stated above, the act of voluntary euthanasia itself can be regarded as being good, rather than bad. Therefore when no harm is done, the doctrine of double effect has no relevance. Related is the debate between ‘omissions’ and ‘acts’. Some try to argue that the killing of a person is bad, but letting someone die is not. The author argues that the act of killing in itself is not wrong.

A third argument is that with the palliative care of today, voluntary euthanasia is unnecessary. Although recognizing that we have made incredible advances in medical care, palliative care comes with trial and error, and the associated suffering. Palliative care and hospices are also only available to a small proportion of people suffering. Most importantly, some people wish to die without getting the care, to remain autonomous. Non-universality, no guarantee of relief and possible unwanted consequences of palliative care make this a non-substantive counter-argument.

A fourth and final argument is considered with what is called a slippery slope. This effect was made famous by an experiment by Milgram where normal people ended up giving very large doses of shocks (450 volts, which were not real) to another person when each time the voltage increased only by 15 volts. This principle doesn’t apply to voluntary euthanasia. There is a distinct moral line between voluntary and non-voluntary euthanasia. The former is with consent, doing more good than harm, whilst the latter is without consent, doing more harm than good. Also in practical terms, the amount of VE and PAS have increased the last years in The Netherlands, but have shown no cumulative growth, nor cases of non-voluntary euthanasia.

A person can, and should be allowed to, competently and persistently request, and be allowed to, engage in voluntary euthanasia. All arguments against it have proven futile, and people should, therefore, be allowed to die with dignity.

References & Further Reading:

1. Peter Singer & April Dworetz, Practical Ethics, week 5; Topic 6: Making life and death decisions for infants.  Guest: April Dworetz

2. Peter Singer & April Dworetz, Practical Ethics, week 5; Topic 7: Voluntary euthanasia and physician-assisted suicide.

3. Young, Robert, “Voluntary Euthanasia”, The Stanford Encyclopedia of Philosophy (Summer 2014 Edition), Edward N. Zalta (ed.)

4. Milgram, S. (1963). Behavioral study of obedience. The Journal of Abnormal and Social Psychology, 67(4), 371.