Exploring Euthanasia: A Good Death Debate

Euthanasia, derived from the Greeks words eu and thanatos, literally means a good death (Holt, 2008, pp. 257). The intention of euthanasia is to provide terminally ill patients with the option of dying a dignified death; this is not a curtsey provided by many terminal illnesses, which are often accompanied by debilitating pain which often leave patients unable to care for themselves or participate in their own lives. “Respecting a patient’s autonomy is an important concept in the euthanasia debate.” (Holt, 2008, pp.268) there are two types of euthanasia: passive and active. Passive euthanasia is defined as withholding or withdrawing of life-sustaining treatment (Collier & Haliburton, 2015, pp.320) and is currently legal in Canada. Active euthanasia entails a deliberate action to end the life of the patient, and can be voluntary, none voluntary, or involuntary. Currently in Canada all forms of voluntary active euthanasia are

illegal.
In this paper I argue in favour of legalizing voluntary active euthanasia in Canada.

As individuals with have the freedom to make autonomous decisions regarding our lives, our health, and the quality of life our life. I will begin by defining the types of active euthanasia. Next I present the premises for my argument, followed by possible criticisms for each premise. Lastly, I will address a counterargument to my argument and offer a reply. The goal of this paper is to make a compelling argument based on the principle of autonomy as to why voluntary active euthanasia should be legalized in Canada.

Voluntary active euthanasia is a deliberate action to end the life of the patient, at their own request, with full informed constant. (Collier & Haliburton, 2015, pp.321) None voluntary active euthanasia refers to a situation where the patient does not physical asked for death, but does make the request via an advanced directive or surrogate, usually a family member who was familiar with the patient’s wishes. (Collier & Haliburton, 2015,

pp.321)
Involuntary voluntary active euthanasia “generally means without the consent or even against the wishes of the dying patient.” (Collier & Haliburton, 2015, pp.321) Assisted suicide differs from voluntary active euthanasia as it refers to a situation were a person (physician or not) helps the patient set up the conditions for suicide, but it is the patient themselves that performs the action that brings death. (Collier & Haliburton, 2015, pp.321) For the purpose of this paper it can be assumed that when I refer to euthanasia, unless otherwise noted means voluntary active euthanasia which incorporates assisted suicide.
The word autonomy is a compound made up of the ancient Greek words for `self' (autos) and `law' (nomos) (2015). Simplified, autonomy means individuals have the freedom and right to govern their own life, and the choices they make with regards to their life. The principal of autonomy states that “competent individuals have the right to be self-determining” (Collier & Haliburton, 2015, pp.439) and that as a consequence of this we (society) have to respect their preferences and choices in matters regarding their lives and health. (Collier & Haliburton, 2015, pp.439)
As individuals we have the right to make autonomous and voluntary decision’s regarding the way we live our life as long as our choices do don’t harm other people. If we are currently afforded the right to determine how we live our life, than following that logic we should also be afforded the right to determine the how that life will end. When practicing autonomy the individual is making decisions regarding their life, since dying is part of life, they should be able to make decisions regarding the manner in which they die. The principle of autonomy acknowledges the rights of individuals to self-determination. “Self-determination is valuable because it permits people to form and live in accordance with their own conception of a good life.” (Collier & Haliburton, 2015, pp.321) If illness has created a life for an individual that they longer feel matches their definition of a good life, then the individual has the right to determinate their life.
Opponents to euthanasia such as Callahan would disagreement with my premise and argue against the acceptance of pro-euthanasia arguments that are concerned with the principles of autonomy and self-determination. Callahan argues that the principle of autonomy or self-determination does not apply in this instance. Since another person is involved in the situation, it is no longer considered autonomous action that simple only affects the patient. Euthanasia brings a second party into the situation, and shifts the request/action on to this second person, therefore no longer making it self-determination action. Callahan claims that “Euthanasia is thus no longer a matter only of self-determination, but of a mutual, social decision between two people, the one to be killed and the other to do the killing.” (Callahan, 1992)
I would respond to Callahan by pointing out that in Canada we already have the legal right to shift our right of self-determination to the physician we make the request for the withdrawal of life sustaining measures, and with this in mind shift our right of self-determination to the physician again with the request for euthanasia.
In Canada it is legal to request voluntary passive euthanasia after informed consent has been acquired. Informed constant is obtained after all the facts surrounding a medical intervention have been explained to the patient. Informed consent indicates that the patient has a true understanding of the details, implications, and consequences of an action. Subsequently, one can request that all life sustain treatments including ventilators, feeding tubes, and intravenous hydration be removed after it has been explained to you that these interventions are keeping you alive. This is an example of our right to make autonomous choices regarding our health. To conclude, if we have the right to refuse treatment that supports life and leads to death, then we should also have the right to request treatment that will lead death.
A criticism of this premise is that the right to refuse life sustaining treatment should not be viewed as a right to end one’s life. “The right to refuse treatment is primarily related to the fact that treatment can be futile or burdensome”. (Robertson, 2004) Opponents to euthanasia argue that the right to refuse treatment should not be extended to requests for death, and is only an argument that can be used to support voluntary passive euthanasia.
Lastly, patients have the right to make autonomous decisions regarding their quality of life. Quality of life is a dynamic concept that examines the positive and negative attributes that influence an individual’s feelings of health, comfort, and happiness. In situations where illness has decreased quality of life to a level that is no longer constant with the patient’s values, the patient should be able to invoke their autonomous right to euthanasia as a treatment. Utilitarian theorists would argue that euthanasia is a moral act because it is increases happy and good for everyone involved, by decreasing the hardship and sadness felt by patients, family, and the medical team. The act of euthanasia removes suffering for the individual, family, and promotes happiness/good for society (Crocker, 2015). Opponents of euthanasia would argue that this view is too narrow and “displays a specific interpretation of quality of life” (Robertson, 2004) which result in people requesting euthanasia for the wrong reasons.
At this point, we need to consider the following counterargument to my argument; voluntary active euthanasia will lead to involuntary active euthanasia because not all voluntary choices are truly autonomous. Opponents to the legalization of voluntary active euthanasia are certain that it will lead to involuntary active euthanasia because of difficulties in determining whether or not the patient’s decision was truly voluntary or subject to coercion.
In order for a decision to be completely voluntary it needs to be free of internal and external coercion. Internal coercion is an internal factor (something inside the individual) that uses power or force to compel an act or choice. An example would be drug addiction, as it causes an individual to seek out more drugs. It is not the person seeking out drugs it is the addiction. External coercion is an outside factor (family or friends) that uses power or force to compel an act or choice. When one is terminally ill there is a tendency for the individual to feel like a burden to their friends and family. Opponents of euthanasia fear that these feelings, coupled with the financial pressures and stress that terminal illness imposes on the patient and family will lead to the use of euthanasia as a method to relieving worry and stress. These pressures are an example of the type of external coercion that will result in a decision that is not voluntary and in consequence not truly autonomous.
My rebuttal to this counterargument is to increase the research, quality and access of palliative care services to ensure that the decision to request euthanasia is voluntary and it is made only as a last resort. “Competent palliative care may well be enough to prevent a person feeling any need to contemplate euthanasia.” (Bbc.co.uk, 2015) Increasing funding and research for palliative care will lead to the discovery of more effective palliative treatments that will allow the individual to live longer, free of the debilitating side effects associated with terminal illness. Furthermore, increasing access to good palliative care is another way to ensure that the individuals request is voluntary. Good palliative care offers relief and support to not only the patient, but to the family as well. Proper support can elevate the pressures on the patient and family, the patient will no longer feel like a burden and the stress related to caring for an individual with a terminal disease is minimized. If good palliative care was available to every patient, it would “certainly reduce the desire for death to be brought about sooner”. (Bbc.co.uk, 2015)
Voluntary active euthanasia as a form of treatment should be made available to all those individuals coping with terminal illness. In this paper I have proven that we as individuals have the right to make autonomous decisions regarding our lives, our health, and the quality of life we wish to experience. Given that right, voluntary active euthanasia should be legalized in Canada. Opponents to voluntary active euthanasia have valid concerns, and there are measures that can me implemented to mitigate and minimize those concerns. A common argument against voluntary active euthanasia is that not all voluntary requests are truly be autonomous. Increasing the quality of palliative care and access to this service is one way that we can ensure that the request is voluntary and comes only after all other treatment options have been exhausted.